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_ � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX d25-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SRE ADDRESS PARCEL TA%I.D.M PERMIT• <br /> 6 is ����yn - , <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 CI7YILP PHONE 2v . / , 2'L <br /> � <br /> ��En , S✓����� � . /�s�.� �����,�m� t�r2��� �s �� ; <br /> TENANTNAME � CONTACTFORPERMR �HONE <br /> - ;r��� �n (z`'� �s � - 8� Z <br /> CONTRACTOR ADDRE55 CITVTP PHONE <br /> CONiA.LICENSE M <br /> USE OP BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �— <br /> � {— _Electric �Gas_Other <br /> WORK DESCRIPTION �' "' � <br /> t..1�,_ � � �vl ��Jf /12.�� p,Lev.�� L-�_'' r`� <br /> f <br /> PLUMBING MECHANICAL <br /> NO. 7YPE OF FIxNRE OR ITFM NO. NPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handlirg units <br /> BathNb Forced air systems <br /> Lavatory(wash basin) Gas pipirg <br /> Shower Water heafir <br /> _ Kitchen sink 8 disposal � Gas firepWce <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laund�y tray Range hoad <br /> Sink(servicelbar/mopletc.) Exhaust fan <br /> BacAilow prevenler Heat pump <br /> Uiinal Unit heater <br /> Dnnking FounUin BoBer <br /> Fbor drain RehigeraUon <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CRY OF EVERETT LOCAL SALES TAl(CODE IS 3105 <br /> 1 heraby centify that I have�ead ard examined Hus appliwbon and know tha sema m be hue and conect. PJI provisions of laws and <br /> otdinaces goveming this rype of viark will be compiied wilh wfiether specified harein or not Tha granting of a pertnR does not presurtre <br /> to give authorfty to violate of can el the pro�ision of any other state or lowl law regulaEng construcuon or the performance of <br /> construction.Th I am a ori d by tlie o�mer of this property fi pertorm the work br which appGcaEon is made ard 1 comply with the <br /> State Co ct Law .27 C�V and 296200 WAC. <br /> �— � �� i <br /> �L i � . � t..c J ? �-'�fo <br /> Sgnature of Owner o tr ctorl•uthonxa Agent ate <br /> r <br />