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PE��MIT APPLICATIO�J <br /> CITY OF EVERETT PERMIT �ERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTEf' FRUM 8 AM TO 4 PM - OEF31T 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAl(�D.p PERMIT# <br /> _ _ � MC4 bq-D/�, <br /> LEGA LOT N0. BLOCK T71ACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PNO E <br /> !/�c�l�u � Lv-u�f'in��� N�s1e�r�uK l�/y /�/>"PJ1 �r%.� Eveoe�f ��� 9'8z0 <br /> TENAiJT N E I CONTACT FOR PERMIT��S!�n� ^ ��S/ <br /> / <br /> CONTRACTOR AODRE35 CITY2IP PHONE <br /> CONTR.LICENSE M <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> _Electric �Gas_Gther <br /> WORK DESCRIPTION <br /> �ui� /�c� �ui� �� S �� ��� oc./r�� <br /> PLUMBING MECHANICAL <br /> N0. TYP£OF FIX NRE CR I7EM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handli�g units <br /> Bathtub Forced air syaleo:a <br /> _ Lavatory(wash basin) � Gas piping <br /> Shower Water hoeter <br /> _ Kilchen aink 8 disposal Gas flreplace <br /> _ Dishwashar /� Gas range <br /> Clothes washer Clolhes dryer <br /> Laundry tray Range hood <br /> I _ Sink(service/barlmop/etc.) _ Exhauat 1an <br /> Backtlow preventer Heat pump <br /> � Unnal Unit heater <br /> Drinking Fountain Boller <br /> ' ^ Floordiain ReMgeretion <br /> . Grease lrap Woodstove <br /> = Roof driins _I Other <br /> � Othor <br /> CIT/OF EVERETT LOCAL SALES TN(CODE 19 7103 <br /> I hereby ceritity that I have read and examined Ihis application and know the sa�ne to be true and correct. ,�II prcrvisions of laws and <br /> ordinaces goveming this rype oi work will hc complied with whether specifieC harein or not The grenting o(a permit does not pr3sume <br /> to gwe authonty tr violate or caneel the proei;;ion of any other stata or local law regulating consWctlon or the peAormanee o� <br /> construction.That I am authorizetl by the owner of this pruporty lo perlorm the work for which appiicatlon is made and I comp:v wilh the <br /> State Con¢acror aw '�RCW and 296.200 WAC. <br /> .�l ��,�� , ��/O =O�/ <br /> Signature o OwnenC tracconAuthonzea Agent ate <br />