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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.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br /> SITE ADDRESS S� <br /> PARCELTAXI.D.A PERMIT�R _ oO, <br /> � d ODOO <br /> LEGA LOT NO. BLOCK TRACT OR SUBDMSION t <br /> DESC. C�n.�p pMONE <br /> OWNER ADDRESS <br /> � 1 3 CONTACT FOR PERMR PHONE <br /> TENANiNAME <br /> EaAAII <br /> ��,/�s�.�,h�to� �1 �+��u\ �a5 a��sw, C�s,hoZ� ��G qe�,a�l ���.s3u1-�y�y <br /> CONT .UC NSE A � � P S Nz � G q\�L`1� <br /> USE OF BUILDINti HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _.Gas_Other <br /> 3 �9, �� <br /> WORKDESCRIPTION ,()� R �j� �O/v '�+�'�n�'� <br /> �` J <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXTURE OR IiEIA <br /> NO. TYPE OF FU(7URE OR ITEM <br /> ro�ie� nrc—aa ne�arn9��ats <br /> -- Forced afr systems <br /> Bevalory(wash basin) � Gas piping <br /> Shower _ Waterheater <br /> Kitchen sink 6 disposal _ Gas fireplace <br /> Dishwasher _ Ges renge <br /> Clolhes washer _ Clothes dryer <br /> — Range hood <br /> _ Water heater Exhaust fan <br /> _ Sink(servicebadmopletc.) — Heat pump <br /> Backflow prevenler UnK heater <br /> _ Urinal — Boiler <br /> _ Drinking Fountain — Refrigeration <br /> Floordrain — Woodstove <br /> Grease trap Other <br /> Roof drains — <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS�705 <br /> I hereby ceAify lhat 1 have read and examined this application and know the same to be true and corred. All provisions of laws and <br /> ordinances goveming this type of work will be complied with whelher specified herein or nol.The grenting of a pe�mit does not Presume <br /> to give authority to vidate or cancel ihe provision o(any other state or bcal law regulating construction or the performa�ae of <br /> construction.That I em authorized by lhe owner ot this property to perfam Ihe work for which application is made and I comP�Y with the <br /> State Contradors Lew 18.27 RCW and 296.200 AC• <br /> t � �/ /��.L <br /> Si� re o Owned niractor/ ulhonzed Agenl Date <br />