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�� PERMIT APPLICATIQN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.averettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �_0 � .-�� <br /> StTE ADDRESS l' PARCEL TAX I.D.� PERMIT# , , <br /> � �' � ��15`121o����n ��� 5� � - �� <br /> LEGAL LOTNO. BLOCK T CT <br /> DESC. E " (� <br /> OWNER ADORESS CITYZP PHONE <br /> �( r�h�li��al �rn1���1tlonf�S, ILC PO. B�x1�0-f�rlinGtn71 Wl�9f�2?3 �125-,�J��I�Io <br /> TENAHTNAME CONTACTFORPERMR PHONE <br /> N� {� � 1�enniS V�I�iqleSu�cY�h y25-34�-45(�2 <br /> CONTRACTOR n IOI I I IUlXA1J C�S�� I I�I I IYSADDRESS CINIZJP PHONE <br /> IV <br /> CONTR.UCENSE� �oRr�cH-y��co P 0. gox 130-�r1 i r�i�n,w�- 9�223 �a5343-45� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> \j l n �i M� � �SI� _Electric �Gas_Other '"" <br /> V lX l.0 1 I <br /> WORK D CRIPTION <br /> Vil�cl �rame Si n��. �c�mi� RQsici�ncQ. <br /> PLUMBING MECHANICAL <br /> N0. - TYPE OF FlXTURE OR ITEM NO. TYPE OF FlX7URE OR fTEM <br /> % Toilet AIC—airhandlin3units <br /> Bathtub Forced air systems <br /> Lavatory(vrash basin) Gas piping <br /> Shower_ Water heater <br /> T Kitchen sink 8 disposal Gas fireplace <br /> —T Dishwasher Gasrange <br /> T Cbthes washer � Clothes dryer <br /> _ Laundry hay � Range hood <br /> Sink(servicelbar/mop/etc.) �haust fan <br />- Backtloiv preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ 6oiler <br /> Floor drain Refrigeration <br /> Greasetrap _ Woodstove <br /> � Roof drains Other <br /> =I Other = <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordioaces goveming this type of wodc will 6e complied with whether specified her�in or noL The granting of a permR doc s uot presume <br /> to give aulhority to viotate or cancel the provision o�any other state or loql law regulating construction or the performance of <br /> consVuctiqq�� That I am author¢ed by the owner of this property to pertonn the work(or which application is made and I comply with the <br /> StatQ-8o trado�td v 8,27� 9 .200 WAC. <br /> � � �U i i <br /> S g ture O o a ' ulhon e Agen ate � <br /> � �v� <br /> ----- � <br />