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ERMI�' APPLICATI N <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 /> CCLUB�IUUSE App�ICATlONS ARE ACCEF'TED FROM 8 AM TO 4 PM ' <br /> 911E ADDRlSS PARCEL TAl(L�.# PERMIT�F <br /> 40l �-t c,�oo��c�lou Mo�ol-o4c� <br /> LEG LOT NO. BLOCK 7RACT <br /> DESC. '�1�A <br /> OWNlR ADDRlSS GRY.21V N'LS� <br /> F F C��.ownarn- L,� l�iNo� '�0�`'� w. $� � w�,°�°3v �9�y a <br /> 7iNANTNAME GONTAGTFORPfiRM1T PNONE <br /> �� Dr�oPnuwr l� P I P�.1 Co��,vA� � '��-S 37-g -v-toD � <br /> CpNTI�¢Tpg ��.��m�KS ��,J(. ADDRESS�I�� CITY2IP 2A� � <br /> �41r� 'Z2o� 9+J l0 q$O-+3 <br /> co�rrn.���Ns�«M�M.Zv� 1�i�y ��uctG.¢owtt- 31r2-^31-1'3(� <br /> US�OF BUILDING NEAT SOURCE CONTRACT PRICE OF WORK <br /> � �v.."i� v.7 <br /> C�1t3�S� � �Elcctric �Gas_Other 33� Q�� , �' i <br /> WORK DB9CR1PT10N � I <br /> NV'AC, -- N�.v.t C�►�srw,u-,o�.� �m�T���w I <br /> PLUMBING MECHANICAL <br /> NO. 7YPE OF FlJCSURE OR ITEM NO. TYPE OF FU(TURE OR ITEM <br /> Tollet � AlC—alrhandllnpunits <br /> Bathtub ,� Forcedairsystems <br /> Lavatory(wash basin) � Gas piping <br /> __,._ Showor Water hQater <br /> KRchen sink&disposal Z Gas tireplace <br /> Dishwaeher Gas range <br /> Clofhes washer Ctolhes d��cr <br /> Watorheater � Rangehood <br /> Sink(acrvlcalbedmoplelc.) � Exhausttan <br /> Backflow proventer Heal pump <br /> _ Urinei —J Unit hvator <br /> _ Drinking Fou�hin Boiler <br /> Floor dreln � Refrigention <br /> Greaee trap Woodstove <br /> Roof dnins —' Olhar <br /> Other <br /> , GITY OF EVERETT LOCAL SALES 7AX COD�IS J105 <br /> I hereby cerifify thet I havc rsad end exemined thls appll�tlon and know the same to be tr�e encl cortect. AII orovislone of laws and <br /> ordlnaces poveminp thi�typo of work will be complied wlth whather specMted hareln or not.The p2nttng of a pertnit dooa not presume <br /> to give aulhori to violate or eancol ehv pro�lslon ot any other ytatY or loeal lew regulating conshut6en or ths perfartnana oi <br /> conscructlon at I am eu o ed by the ovmar of thls property to peAortn the work for which app�lea4on Is made and 1 comply�vith the ' <br /> Steto Con ora Law t CW end 298.200 WAC. ' <br /> v.�� � 10 � �P i <br /> Slpnat nar ctotlAuthorized Apent �• I <br /> I <br /> `�,0�^O\, <br /> U`I� <br />