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rJE. �1. 2';�� 1 J� 7Jn�l� i��i. r1L�E f. . <br /> � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERET7, WA gII201 <br /> A25�257-8810-FAX 425•257-8a57-vnvw.evereftwa.orp <br /> APPLICATIONS ARE qCCEPTEb FROM 8 AM TO 4 PM <br /> 4? '� �13 <br /> SITE ADDRESS PARCEL TAX I.D,if <br /> ` ` ��� PERMii Nq <br /> �EGA LOT N0. BLOCK TRACT OR SUB�IVISION k �O V"O <br /> DESC. <br /> OWNEH quoREss <br /> �� \ e ����Q� CITY2IP 2PHONL <br /> � �� ►}25 58 ►3?3 <br /> ervn�v r nqnE I COMaCT FOFi pEFM1T <br /> PHONE(,�'L5 Z • �.� <br /> `� �� e.�,�a E��IE'Q`L���11/�{r. Qi>i <br /> cm�ea nq Inc. �4�� $ w�o� �vexerf qg��c,� ►�z52���6� <br /> CONTR�L_f�CEI SE •, O R� <br /> rr� <br /> USE OF DUILDING HEA7 SOURCE <br /> � / CONTppCT PRICqE OF YlORK <br /> _Eiecinc ✓Gas_Oiher ���0 1� <br /> �'�ORK DESCRIPTION (` � , <br /> 1"Ufa�'����Q11,+2� � Tl h4.��G..CR� . ��'1 S��� r-{LtS I N S�� • � �S� � � <br /> ru,u�� ss ba�(e� r� r, � „¢�` �.�'tv bo� I�ew' <br /> PLUMBING MECHANICAL <br /> ���� TYpE OF Fl%TURE OIIITEM NO. TYpE OF FIXTURE Oli ITEAt <br /> � Bithltub ____ NC—au hendlinp unrts <br /> _ Lavatory(wa;h basin) Forced air systems <br /> Showar � Gi'S pipinp <br /> _ KllChen slnk 8 disposal VJater heater <br /> ,_ Dish�vaehcr �_ Gas Ilreplace <br /> _ Ctothos washer — Gas ranpe <br /> Water haaler _ Clathes tlry�r <br /> � Sink(sorvice/baqmop/etc.) ._ Rpnge hootl <br /> ^ Cack(Iow praventer _ Eztmust lan <br /> � Urinal _ Neat pump <br /> � Odnkinp Fountain Uri(haaler <br /> Floordrain —�— `����� <br /> � Grease trap _ Retriyeration <br /> Aool tlrains � 'Nao�stovc <br /> _ OIhOf .�_ Olher_ <br /> �_� <br /> CITY OF EVERETT LOCAL SALES 7AIC CODE IS 3705 <br /> I hireUy ceritity thal I have reatl and ekemined Ihis applicnlion antl kno��lhe samo!o b�Iruo and correcL All provisions of laws and <br /> ordln�ces govorninp Ihis lype of woik wlli be complled wilh whether specllied herein or noi. Thu praming ol a permil doe,not prE;ume <br /> lo ylv� aulhotlty fo oiolate or cancel 1he provlslon ol any olhar s1a10 a local law requlslinp conslnic�on or Ihe portoim¢nco or <br /> cor;uvclion. 7ha1 I am aulhorizetl by itte ownor ot ihis propr.ny�o pertorm Ihe w.ork tor whleh applicaii0n is mado and I comply�y;�h the <br /> Stale Comractors Law 78.27 RCW and 296.200 WAC. I <br /> ` —�__� [J� '� - <br /> SiPnaW ot Owner/Copt nCtorlAuth genl ^ �pa�� <br /> 1..� I <br />