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O�l. 5. 2012 ]: OOAM �10. 5365 P. 2 <br /> � . � <br /> PERMIT APPLICATION <br /> CITY OF EVEREIT;PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425•257-9857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEY7ED FROM 8 AM TO 4 PM <br /> SITE ADDR6SS PARCEITAX I,D.# PERMIT M <br /> lon�� �/ �SB201 z.l(�-ol � <br /> LEGAL LOT N0. e�ocK TRACT Op susoIV1910N tl <br /> DESC. <br /> OWNER AD�RESS CITY21 PHONE <br /> ��p �,lfSc�n �xwxR �2� �2�b q�� <br /> TENA NAME CONTACTFORPERMI7 PHONE(,�'Z� 2� (�,(p(.p <br /> I �e E•MAI .�G�bl� ���. <br /> cmN2a'nqinL +4�5.Br uaa�.� cve,rett ag�Zoi i�Z52 i�t�66�O <br /> CONTfiC`�� S�� oG 5R� � <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PHICE OF WORK <br /> Eleclric �Gas_.Other 35�3,�Q <br /> WORK DESCRIPTION <br /> Re,plo�cu. Gust c�as fvr�qce - ���—r� � <br /> PI.UMBING MECHANICAL <br /> No. TYPE OF FlXiURe OR�TEM N0. TYPE OF FlXTURE OH ITEM <br /> Toilel A/C—air handlMA units <br /> Baihwb _ Forced air systems <br /> _ Lavalory(wash basin) Gas plping <br /> Shower . � Water heater <br /> KitChen slnk R dlsposal _ Gas fireplace <br /> � Dishwasher � Gas range <br /> Clothes washer _ Clothes dryer <br /> � Water heater RangC hood <br /> Sink(service/barlmop/etc.) Ezheust fan <br /> �ackilow preventer � Heat pump <br /> Urinal � Unl[heate� <br /> Dfinking Fountaln ,_„_ Boller <br /> Floor drain Relriperallon <br /> _ Grease trap Woodslove <br /> Fioo(drains � Olher S YI <br /> Other <br /> CITY OF EVEqETT LOCAL 8ALE9 TA%CODE 19 3105 <br /> I hereby ceritify thal I have read and examined this application and know the same to be Irue and correcl, All provisians of laws and <br /> ordinaces governing this�ype ot work will be complied with whether spacified herein or not.The granling of a permit does not presume <br /> to glve authorlly to vlolate or cancel the provtston ot any other state or local law regulatin0 construc8on or the performance of <br /> construction.That l am authorized by the owner oi this property to pertorm ihe work lor which applicalion is mada and I comply wllh the <br /> Stale Conlractors Law 18.27 RCW and 296200 WAC. <br /> 1�k� �c �D • 5�i2 _ <br /> Slgnew of Owner/Copl actod ul ¢ Agent Date <br /> (i <br />