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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM (�...��� <br /> SITEADDRESS �;39 2 8 0 03 00 50o P�Mrcx .Z-UU <br /> Co9lto OL'(MPfC DR1�/E <br /> LEGA LOTNO. BLOCK TRACTORQUBDIVIs�q�+R <br /> DESC. S 3 ��VERL� HtLt_5 DtJ I <br /> OWNER ADDHESS qTY21P PHONE <br /> z�.w� � M�kE �t�o�. �q 14� OL'CMPIc �R�V�. E�E�-tT 98203 �425-353• 433� <br /> TENANT NM1E CONTACT FOH PERMIT arro►+e .�25-377-$76 n <br /> Is��Ae-r cG��T E�u�STuGI.�FT@AoL .coh{ <br /> �� <br /> CONTR.LICENSE/ -- ��� r <br /> � � <br /> USE OF BUILDING 5 HEAT SOURCE CONTRACT PRICE OF WORK <br /> �eS 1 G���t�.L. I _Electric _Gas L Olher I <br /> WORK DESCRIPTION <br /> �1.� �C�C.i,fl Jrl � Ce�c;.-�-- ' '��'H�2bY"i ' �L1 r�'�" (�'�P't''1C. Z�C7 <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF Fl7(TLRE OR ITEM NO. TYPE OF Fll(TURE OR ITEM <br /> � Toilet NC-air handling units <br /> Bathtub J Forced air systems <br /> Z Lavatory(wash basin) Gas piping <br /> � Shower Water heater <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwnsher Gas range <br /> � Clothes washer � Clothes dryer <br /> _ Water heater Range hood <br /> _ Sink(servicelbar/mop/etc.) � Ezhaust fan <br /> Backflow preventer Heal pump <br /> Urinal Unit hea�er <br /> _ Orinking fountain Boiler <br /> Floor drain Relrigeration <br /> Grease irap Woodstovo <br /> Rool drains Othcr <br /> Other <br /> CITV OF EVERETT LOCAL SALES TAII CODE IS 3105 <br /> t hereby ceritity that I have read and examined this application and know the same ro be true and correct. All provisions ol laws and <br /> ordinaces governing ihis type ol work will be complied with whether specAied herein or not.The granting af a permit dces not presume <br /> to give authority to violate or cancel Ihe provision of any olher state or local law regulating construction or the pertormance of <br /> conslmdion.That I am authorized by the owner a�ihis property to perfortn the work for which application is made and I comply with the <br /> Sta'¢�onlrac rs La �827 RCW and 296.200 WAC. <br /> =--��-- � ���� �� <br /> e�: 2- �— <br /> Signature of Owner/Contract /Authonzed Agen� Date <br /> '/Z <br />