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f <br /> i <br /> PERMIT A��LICATION <br /> CITY OF E,VERETT PERMfT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> �ZS-257-8810-FAX 425-257-8857-www.averettwa.org <br /> APPLICATIONS ARE ACCEPTEb FROM 8 AM TO 4 PM 9` a g"�� <br /> SfTE ADDRESS PARCEL TN(I.D.f1 PERMRi <br /> �5 }��¢ll(�-1�� �p, O'.J�r��1 =rCc7 I r�l�D �C�zS�X�-U01 <br /> LEG LOTNO. BLACK iRACTORSUBDMSIONf • <br /> DESC. I —I I 'D -DD S'(�A��L �.lif.�i i 1 pIJ T✓ LJL��=lT 7J0• 3 � <br /> OWNER ' AODRE33 CITYI7JPI�2N, PHONE <br /> �� c4� iAM/��r/ Y�tJ=- 3as N��-r+-l��. �v, ��u�=`i"i �lz> 2-.,r � i. ; <br /> TENANT NAFIE I CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> ��7+i l U,� � T�L aoo ss PO �;; 3Dl� ci v <br /> WG�Dl�IVI�ZZ � '2� t)c:��a.,.� <br /> c«r,R.uc�se. wC•-�-�'T �-1���G^1 r'1 �l�'o'Iz <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK <br /> >�nic� �� r�l�+i�y _�,� ��_o�,a� � � �-� �/— <br /> WORKOESCRIPTION FAM � �y �jc.�M ��7/7 Ot�� � P-� � <br /> ! , �I=�z�M �1�>r' �_�J �- t.��.a <br /> Deck-- <br /> PLUMBING MECHANICAL <br /> NO. TYFE OF FUC7IJRE OR ITEM NO. TYPE OF FIXiURE OR REM <br /> Toilel A/G—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water hoalor <br /> Kltrhen sink 8 disposal Gas fireplace <br /> Dishwasher Gas renge <br /> ,� Cbthes washer � Cbthes dryer <br /> Water heeter Range hood <br /> � Sink(servkelbadmop/etc.) ��NPI'`� ��I��{_ � Exhaustfan <br /> Bacldlow preventer Heat pump <br /> Urinal Untt heater <br /> Drinking Founbin Boller <br /> Floor drain Re(riperatlon <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 � <br /> I hereby ceritify ihat I have read and e�ramined this appllcaQon and know Ihe sarne to be We and correcL All proWskms of laws and <br /> ordinaces govemfnp this type of Hrork will be complied wilh whefher specHied herein or noL The grantlng o(a pertnit does twt prestane <br /> to give authority to violatn or pncol the provlsfon ot any other siste or bcal law ragulating constructbn or Ihe performance of <br /> constructlon.That I am authorizod by tho owner of this properly to perfortn the wnrk for which applfcaUon is made and I compty with the <br /> State ConU o�s Law 18 7 R�, d 96200 WAC. <br /> �,��:��Ul/,�,�`%,(�i�hi��. a ��l�� <br /> Signalu�o Owned ntractndAulhorized Agent� Dale �� <br /> �— <br />