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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-vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM C _�2'� <br /> SITE ADID� RESS PARCEL TAX I.O.A /PERMIT N <br /> S� U! �P�'muJ'C.. .3g03' � � OU t <br /> IEGA LOT NO. BLOCK 7RACT OR SUBDIN310N t <br /> DESC. NIS o�aS i a 36 - o o '�� errt� D L �n'� <br /> �"" "° ss 4�r 3sy-5 ys <br /> Co � .� ��er.r„c � 1�-33 I ex�� Av� r�.'�s ��-�1� ,�w 4 �/09 <br /> 7ENANT NAME COMACT FOR PEAMT Pf10NE <br /> Co��, U clly ��(Y1�i1��Y I��r� f�i�tvlmi C!' E�IAILC�O r�1(CIT � S�Ya�ic •. �.� <br /> �,��•-k �y OV-•(: <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> —rt S�Af h�C.� p Elechic�Ga� _ ._Other <br /> WORK DESCRIPTION <br /> t'e •plu...�, nc.a c��y�,�Hl� �..,�I� �..�.,�f�,��a.., �n �tR�l�,-,� y �s <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl)RURE OR IiExl NO. 7YPE OF FlaT1N�OR REM <br /> I Toilet NC—air hendlirg units <br /> / Bathtub Forced air s stems 1 <br /> _ � Lavatory(washbasin) X Gaspiping��+Sa�yr�.�'�oue,��rcP�o.�+�^rIPs� <br /> � Shower � Waterheater ��..i�� h� �� <br /> � Ki�chen sink 8 disposal I k Gas fireplece <br /> _ / Dishwasher i (,, Gas ranpe <br /> _ � Clothes washer ��. Clothes dryer <br /> _ � Water heater Range hood <br /> Sink(service,bai/mop/etc.) � Exheust lan <br /> _ Backflow preventer � Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Groase trap Woodstove <br /> _ Rool drains _ Other <br /> Other <br /> ClTV OF EVERETT LOCAL SALES TAX CODE 19 9105 <br /> I hereby ceritily that I have read and e.amined ihis application and knaw the same to be true and cortect. All provi;i�ns of lews and <br /> ordinaces goveming ihis type of worA+vil�be complied with whether specHieA herein or nat.The grantinp ot a pertnit does rat presume <br /> to give authority to vioiate or cancel the provision of any olher state or local law regulatlnp construction or the pertortnence ol <br /> construction.That I am aulhorized by the owner ol Ihis property to pertortn the work ior which applicallon is made and I comply with the <br /> S n�r c:tors Law 1827 HCW and 296.200 WAC. <br /> �c��— 8//s- o p <br /> 5ign3ture of OwnevContractodAuthonzed Agem � ate <br />