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Feb. 6. 2014 9 40Ah1 �Jo. i166 P. 2/4 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT pERMIT SERVICES <br /> 3200 CEDAR STREET, E\�ER[7T, WA 9p201 <br /> 425-257-8810— FAX 425•257-885 i—w�vw.everottwa.org <br /> APPLICATIONS ;�RE ACCEP7ED FROM 8 AM TO 4 PM -�. �Fj ..11� <br /> 51T[A�DDR[SS �� ��G���� pARCEL TAX I.D.q pEqM1T# <br /> � 5 � � �z_ <br /> LEGAI LOT N0. BLOCK TRACT OR SUB�IVISION k <br /> OESC. <br /> OWNE(1 pD�Rl93 CITY/ZIP PMONE <br /> ��re.n � �Aa�wvi 5a.�vt2 G�� �.1��2 425 �a 2 � 5 I� <br /> TENANTNAM1I[ I CONTACTFOHP@RL11T PHONC�'z� Z�� (3`• <br /> ��i� E.������JeL�bie'CCmhr���ir�.�. c,-,.� <br /> , Gt�'1 �a ��IG� I►1c.. �LHi� �r ��� C..ve,ti�ett qg.�nvn`��IZ�2���_�►a�6�k� <br /> coNrR���i;Ci.l1.L� �q5�t�{• <br /> USE OF BUILDING HEAT SOURCE CON7HACT PqICE OF WOHK <br /> `Eiectric _Gas_Othbr g� �g���^} <br /> d <br /> WORK DGSCfiIPTION <br /> I n�}-a!� qas-�r�ac�. � he�.T p� �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITL�d NO. TYPG OF FIXTURE OR ITEtd <br /> _ Toilet NC-alr handiin� units <br /> _ Balhtub - FOrcod alr systems <br /> Lavatory(�vash Uasin) Gas pipin{� <br /> � ShoK•er Waler heale� <br /> _ Kltchnn s�nk 8 disposal Gas hroplace <br /> _ Dishwasher � Gas ranpe <br /> __ Cloihes washcr Clothes dryor <br /> _ Water heatur Ranpe hood <br /> „_, Sink(servtce/baumop/r.Ic) � [xhausl lan <br /> _ [3aCklloW prCVCnter _J__. 1ir.a1 purnp <br /> _ Urinal Und hcater <br /> Drinkin{�FounWin � yoiicr <br /> _ Floor drain � ~ Rplrigerahon <br /> __ Groase Irap WooJstova <br /> _ ��oo�drains _�� Olhcr c�GS � f v�QLG <br /> Olher <br /> CITY OF FVEP[TT LOCAL 9ALE$ TAX COD[IS 9105 � <br /> 1 herr.by ceritlly Ihql I have rOaJ antl ezaminotl Ihl;appiication and know tho same to bo Uue end correct. All provisions ol laws and ; <br /> orAinacos poveming Ihis Iype ol v.�ork wili bo complled wilh whelhai specilied herein or noL The prantin��ol a pa�rt�d daea n�t presume � <br /> lo qive autl�ority to vlolale or concul lhe provision ol any olher siale or local law re�uialing conslruclion or Uio peilormanco al <br /> construciion. That 1 am aulhorized Dy Ihe ownyr ol Ihls properly to portorm Ih0 work lor vduch npplication is mado and I comply wilh Ihr. <br /> Slate Coniracto,Law t8 27 HCW anJ 296.200 WAC. <br /> . � <br /> � � 7 Z� (p ,� �: __ . <br /> Sgnatu �o Owner/CoyN ac�or/AuUx i� A�unl Uatc • <br /> C� <br /> `� .- -- - --- -------- - --- <br /> \iz-- , <br />