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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.everetiwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAY.:.D.# PERMIT ft . <br /> 30�� v�eTc� � c�.s� �� �o5co3 �� �,c;C� � . ��1`i <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> 0[SC. <br /> OWNER AODRESS CITY/ZIP PHONi� <br /> Tti��- �c-cz�,�s�ci .3�'OS Utc��r2 PL �.9��avi �CzS -�sj--5�lL- <br /> TENANT IIAME CONTACT FOR PEAMIT PHONE <br /> B�Y.�hv ��e�r� 'E��775�G�%��/ <br /> CONTRACTOF; ADORESS CITY2IP PNONE <br /> J7A�r d /�'l i e Ptnal3c�• d H'TG- /l•G f�I �3�i AcY. G<�. L v�✓n1, �{25 �75-G�/G�I <br /> CONTR.LICENSE p �cn .� <br /> D� •- f t c " �w <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRiCE OF WORK <br /> �Electric __Gas ___Other � ��D <br /> WORK DESCRIPTION <br /> ��''Sr�iCC /�Gtt,' rl�l(LTLCSS f��cZ� c/rt2�/ <br /> s����,-c . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet . A'C-a��hrioLng units <br /> Bathtub Forced atr syslem, <br /> � Lavatory(wash basin) Gas piping <br /> Shower _ Water healer <br /> Kitchen sink 8 disposal _ . Gas fireplace <br /> Dishwasher Gas ran�e <br /> Cbthes washer Clothes dryer <br /> Watcr heater Range hood <br /> Sink(service�barlmop'elcJ Exhaus�tan <br /> _ Backflowpreventer _ J _. Heatpump <br /> Urinal _ . Unit heater <br /> Drinking Fountain ._ Boiler <br /> Floor drain _ __ Relrigeration <br /> Grease trap ___ Woodstove <br /> Rooldrains __ Olhcr_ _ _ <br /> Other . _ - - - - .� <br /> CITY OF EVERETi LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritily that I have read and examined ihis applicalion and know the same to be Irue and correct. All provisions ol laws and <br /> ordinaces c�ovem�nc�Ihis type of work will be�omplied with whelher specified herein or not.The c�ranting o�a permit does not presume <br /> to c�rve authonry to violale or cancel Ihe prow�ion ol any other state or local law regulatinc�construction or Ihe performance ol <br /> consL•uclion.That I am aulhori the ow�er ol ihis pmperty ir �erlorm ihe�vork tor which appilcaUon is made and I comply with Ihe <br /> Stale Corll clors Law 18.?7 CW an 29G.2001'JAC. � <br /> =� .t,. � �� ? ' b, � U�� I <br /> Signature of wncr/Contract /Authonzed Agent ate <br /> i . - �- - � -- - -- - -- - - - -- -- � <br />