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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8610 — FAX 425-257-8857 —www.evereHwa.org <br />APPLICATIONS ARE ACCEPTED FRJM 8 AM TO 4 PM <br />SITE ADDRESS . PARCEL TAX I.D. / PF.RMIT A <br />I�i- 3!� 55-nr G✓i SU✓ I�l���Q7POlk'�o72on C' DO_? - DO <br />LEGA LOT NO. BLOCK TRACT OR SUBDINSION # <br />DESC. '?j �� '�N/1$� q' I%�EY��L CREEK PHkyEe ��7i� t� �H� �141LE i4� <br />T�FacldRMihi GUE��R� l�liGi INEZ <br />TENANT NMAE <br />G'�ivNF,� �L�u�'ieD <br />coNnt. uceNse s <br />1330 55,,r ST 5w EYc�.:;,- agZo3 qas-�p7- <br />CONTACT FOR PERMIT PHONE � 2 r.� ����_p53 � <br />J�r-F�-Y bi,�-r� - --.. .�rn�„r..�, -��--- <br />SE OF BUILDING HEAT SOURCE CONTRA� reUCE OF WORK <br />I 5PA d S/}i.(NA ADPIT/G#1 �'i�%�'ES. iANf'�FJFTED <br />Electric Gas Other �� // � <br />� STL'K�C£ A-DDN lZ� 9� F� R. — — — � � <br />WORK DESCRIP710N <br />i� <br />� ��� <br />�- S <br />�, . /,. O � _ t <br />NO. I TYPE OF F7XTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbarlmopletc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floordrain <br />6rease hap <br />Roof drains <br />Other <br />� j i; � O = Cv� L� c� <br />h l�i . '." '?� � S� <br />NO. I TYPE OF FlXTURE OR ITEM <br />FUC — air handling units <br />Forced air systams <br />Gas piping (8 - Vb.r <br />Wa�r heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Ex F+A USt� <br />I hereby cert'rfy that I have read and examinsd this application and krww the same to be true and cortect. All provisions of laws and <br />ordinances governing this rype of vrork will be complied with whether specifisd herein or not The grenting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local iaw regulating construcGon or the performance of <br />construction. That I am authorized by the owner of this proparty to perfortn the work for which appiication is made a�d I comply with tlie <br />Sbte Conhactnrc i aw +a �� ttCWand 296200 WAC. <br />?. .,, � - 3 �3 0�l v I <br />Signat3r: of O >�ir,,,,nar:torlAuthorized Agent Date � <br />