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ERIQIIT APPLICATtVN <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 8 AM TO 4 PM / � --/'�--/D <br /> SITE ADORESS PARCEL TAX I.D.# PERMIT 1t <br /> 6� z��n �� I�Es�- ou�d-�-��-a,Ps - Z-w <br /> LEG LOT NO. BLOCK TRACT OR SUBDIVISION N . <br /> DESC. <br /> OWNER ADDRESS CiTY21P PHONE <br /> TENANT HAME n C^O�NTACT FOR PERMIT PHONE �-'TZ��-��j7 <br /> �E rUEI_ �[��(J. �-+ID I CC��T��I�l1fp.�T E�MIAIL �BY.�C�NNCCN��L <br /> DRE6 � (,������ <br /> VMx�ro FieE {���e-r.n� fv� Isd3 �vcr�Nv��E �v� � <br /> CON .LICFjNSE�f��� ,. � <br /> �,,,, �i&�7Z �(zs-q� -��T <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��-,�� � _Electric _,Gas_Other � �q 7� <br /> WORK DE6CRIPTION <br /> 11J��j1�u._ I� 7('l..��E�Ul� ���IrJKLEeS iiJ AIEN/ GEIU�:+4� <br /> l <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OP FIXTURE OR ITEM <br /> Toilet A/C-alr handling units <br /> Balhtub Forced afr systems <br /> Lavalory(wash basin) _ Gas pipfng <br /> Shower Water heater <br /> Kitchen sink&disposal _, Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mopletc.) _ Exheustfan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refigeratlon <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicaGon and know the same lo be true and correct. A�provisions ot laws and <br /> ordinaces govorning this type of work will be complied with whethQr spec�ed herein or not.The granting of a permit does not presume <br /> to give authority to violale or cancel lhe provision of any other state or local law repulating construction or the perfortnance of <br /> construction.Thal I am authorizeri by the owner oi this propeAy to perform the work tor which application is made and I comply with the <br /> Stale�actors Law 18.27 RCW and 96.200 WAC. <br /> �c"�i¢�- �. � iZ-16-fo <br /> Signalure oi HnedConlraclodAuthorized Agent Dale <br />