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07/15/2012 20: 30 «0430 P. 002/002 <br /> ` �-G'=.- - <br /> PERMl.T APP:LIC��TION <br /> CITY OF�E`✓ERETT PERMIT SERVICES <br /> 3200 GCOAR STFEET, EV�RETT,WA 98201 . <br /> 425-257-8510�FAX 425-257�8857—www.everettwa.org <br /> APPLICAT1o4S ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE AD�RESS PARCEL 7AX I.D.# P6RMIT ii <br /> `f l G�/ �/�n av� Ar ' � .I ' �2Q —OZS <br /> LEGA LOTNO. BLOCK� � ., . ,TRACTORSOpppll5lONM: • .. . . <br /> DESC. . - � � ' <br /> OWNER �, � .;APPRE55 - CItt2�P PNONE <br /> �eS S `�"��^i'�en Z Ffr �i�— Y i�/ G�/G/r.1�iov�r.; .Or ��9'P�3 `�2�—Z 3 Z— u' 2 <br /> TENavTNnME _ ,� �;; _. CONTAcYFORPERMIT , „ PHONE <br /> . ..-� ^��::,.-.-a� .. _ . E�dAll. <br /> Ejb/�.�,� sQ/rs � �.v� ' 3�6f ��r-¢� ��i` ' y�-_Zs�-2�6i <br /> coNr�.uc�wse a : • ., . . , --�1Pzo`/ .. .. <br /> USE OF BUILDING ' ` HEAT SOURCE �. , CONTRAGT PRICE OF WI�RK <br /> . ., . � � <br /> /�J'S ., .- . �,Electric ,�C',Gas Other ; , : . O <br /> WORKDESCRIPTION �P�uJL..:: �: �r�a��, /��p� (� �!/ii�i /V�� �tis <br /> 0:..,��; , <br /> �rGt4�•�G . . <br /> � . . ,� .. .... r. . . . .. . .. . <br /> PI.UMBING ' ; ' MECHANICAL <br /> No. TYPE OF FI%TURE oR IiSM--�----� N0. :. -- - •7YPE OF FIXI'URE OR ITEM <br /> � :.� <br /> Toilet � AIC.-air handlinp Gnits <br /> Balhtub ' ""''.'�, Fofced air sysiems <br /> ' Lavatory(wash dasin) . � � Gas plping <br /> Shower � Waterhoaler <br /> _ Kitchen sink 8 disposal ---.' • . • � �_ �Gas firoplace <br /> Oishwasher '•-�'�•:,".'�' ' _ Gas range <br /> Clofhes washer • - • ""�`' ' Clolhes dryer <br /> Waterheator _ ^ ;' ; ,,:' _ Rango hood � • <br /> � Sink(serviceA�ar/mopletc.) ;',::.- '{�`;`; �` ' ._ _ Exhaustfan ,:' ', <br /> Backflow prevenler . Neat pufnp <br /> �' urinal � - • • � • • _ Unit hoator • <br /> Drinking Fountain -•-- - Boiler <br /> _ Floor drain .. "..": �' . . ,.._ Refriflerali0n <br /> Grease lrap Woodstove <br /> Roof drains �^ T'-' Other <br /> Other - . f: . __ ' <br /> CITY oF EVERETT LOCAL SALES TAl(CODE IS J105 <br /> I hereby ceritify that I havo read and examined thfs applicatlon and know tha same tu be true and corroct. All provisions of laws and <br /> ordinaces goveming tttis type of work will be complied with Whether epecified herein or nut The granpn8 of a permit does not presumo <br /> to flive authority to violate or cancel the provision of any olher state or local law repulaGnp�nswcUon or fha peRormance of <br /> construction.That I am authorixed by the qwner.nf,this properry to psrfOttn the work(or whieh application is made and I comply with tho <br /> Scace C-�rs La1v 18.27 RCW nd 2s6.2IIn wnr. _ . <br /> /// �I��` �Z <br /> Signature o OwnedContractor/Authonzod Agent y . Date � , <br /> — � i . <br /> . _. .. . . . � � i �. . . , � <br /> � � <br />