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PERMIT APPLICATION <br />CITY OF EVE4�ETT 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 B AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # <br />�lf� IJ��es 5'�' I oo5l�laoo 4oz� o0 <br />LEGA LOT NO. <br />oesc. 21 L, y't� <br />OWNER <br />(�alV� {{a��e✓ <br />CONTR LICENSE t <br />VANSLAI <br />BLOCK TRACT OR SUBDIVISION f <br />ow}o-a� lZ,��kes Pa�k. Rc�;-tiov� <br />ADDRESS ��TYZP PF <br />2�10 (Vl�2S s�' �IJCvGII�W� ��ZO� <br />Res'���Al ( .� <br />cr�i k R� <br />WORK DES�RIPTION �y�(�O�p� <br />c. <br />CONTACT FOR PEwrir <br />�l�d��l (��c. A�d,�k-t� <br />—I � �-/ f� <br />2MIT N, <br />IODo-0� <br />rn.n. ��ov � <br />�,,;ku.�a e �kp <br />�.���iur `'zC�'�ZO ���ii <br />P.o. BoK l3oco6 q- , <br />�Ue„e}E� (,VQ `�'020(0 <br />HEAT SOURCE CONTRACT PRICE OF WOF:K <br />X Eledric _ Gas _ Olher - <br />� <br />2oS s.�. ol ct� ex�s�i�a Sccon� �" <br />�� <br />Wa�����f .�x�-�:�o�� d�� . <br />PLUMBING <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Ciothes washer <br />Water heater <br />Sink (service/barlmopletc.) <br />Backflow preventer <br />Urinnl <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. <br />TYPE OF FIXTURE Of` ITEM <br />AIC - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Ezhaustfan <br />Heatpump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TA7( CODE IS 1105 <br />I hereby certiy thal I have read and examined this application and know :he same to be lrue and correcL Ali provisions of taws and <br />ordinances goveming this type o( work vnll be complied with whelher specified herein or not. The granting of a pertnit does not presume <br />to give authority to violate or cancel lhe provision ot any olher slale or local law regulaling construction or the performance of <br />construction. That I am aulhorized by the ovmer of this pmperty to pertortn the work for which appliration is made and I comply with the <br />Stale Cojjtra ors Law 18.27 CW and 296200 WAC. <br />lM �/ 1� �f Y' "tGf��-' �� � n I <br />�naw�eui.,..����,....��.�....._...._..._..___ . __. <br />wt��l�l A� ��Y�(� ���^��e <br />/� <br />; <br />