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� I <br /> PERMIT APPLICATICIN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32Q0 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-881 U—FAX 425-257-8857—uwvw.everettwa.org <br /> APPLICATIONS AAE ACCEPTED FROM 8 AM TO 4 PM �_ �,_{�� <br /> SITE ADDRESS PARCEL TAX I.D.p PERpMIT ff <br /> � C'✓ .(., -r ._ / . . �L���- �'�(,�_ <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION R <br /> DESC. <br /> OWNER n ADDRESS CITY2IP PHONE <br /> � �. <br /> � �r�- 1i.r�l,hi,,7e•i 7�'Y l�%r.-r��, .�fvP f-�'r,�r�,P( <br /> TENANT NAME � CONTACT FOR PERMfT PMONE <br /> E#IAIL <br /> CONTH.LIGENSE X <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 7 <br /> '7,•.,,!r �••� •. /' ����',. r�•� �'x- EICCtriC _Ga5_DIhCf <br /> WORK DESCRIP710N <br /> i���^�,� e � ,�1 , '� . � .�.- �ti�7�� .����� �t�....�� � 'f S-.YPir,�.-i.i � L /2ci�. � i. .r�; <br /> l,� <br /> `f ��r.. �r � � ,,, r� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR IiEM NO. TYPE OF FlXTllRE OR ITEM � <br /> Toile� _ A/C-air handling uni�s <br /> �athlub �orced air sys�ems <br /> Lavaiory(wash basin) Gas piping <br /> Shower Water heater <br /> , Kitchen sink 8 disposal Gas lireplace <br /> Dishwasher Gas range <br /> _- Clothes washer Cbthes dryer <br /> Water heafer Range hood <br /> Sink(servicePoar/mopletc.) Ezhaust fan <br /> �ackllow prevenler � Heat pump <br /> Urinal Unit heater <br /> Drinking Pountain Doiler <br /> floor drain Refrigeration <br /> _ Greasetrap Woodstove <br /> Rool drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CC�OE IS�1U5 <br /> I hereby ceritily that I have read and examined this applicalion and know Ihe sz me to 9e Irue and correct. All provisions of laws and <br /> ordinaces goveming this type ol work will be complieA with whelher specilied'.erein or not.The granting ol a permit does no�presume <br /> to give authoriry to viola�e or cancel ihe provision of any other state or local�a�N regul2�inp construction or Ihe pertormance oi <br /> consimction.That I am authorized by�he owner ol ihi;property to pedorm Ihe work tor which application is made and I compty with ihe <br /> State Con4raclorsl�d��78.77ACW and 29Fi200�4!".::. / <br /> '� ; � . <br /> � <br /> ;� ,, , � ,� <br /> Sign3� e of r.mM/Coniracto Authorized Agent ' Date <br />