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PERMIT APPLICATIGIN <br /> CITY OF EVERE'i�' PERMIT SERVIC�S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 42r257-8857-N�vw.evereHwa.org <br /> APPLICATIONS ARE A(:CEPTED FROM 8 AM TO 4 PM �-3 (-D� <br /> SfTE ADDRESS Q PARCEL T.�/UqC LD./ PERMR i <br /> �.r2C� La1� R' '/� $ 2&�5� {Q'���Z'k-� �C��G�l 'C`) ' <br /> LE LOTNO BIOCK TRACT � �y, <br /> DESC. q Q{'�,P�'IS �(IVQJ/ �� • � <br /> OWNFA ADDRESS CfTYlZIP PHONE <br /> hllvW (.�tk� f�ec��G�.�,, U.L ("1(si' �'xu.� p� d+.x.. �Srw (Ar,F}o,� <br /> TENAHT N E CONTACT FOR PERMIi P!��E <br /> ��� ��'�'��� I� h'1lNet�t �Ci�'k"(�l�' �, • 2t.to !�?�'�I�- <br /> C TOR ADDRESS CRY/Z1P PHONE <br /> �o�.,oww Gr�uvh 2315 • 13ot� � F�E Bc!(cu�.�� �fas'•2a9�4o¢c, <br /> �*+F q-��_ '�f� Zu� WP.-4f�ocS <br /> USE OF BUILDING HEAT E011RCE I ONTRACT PRICE OF WORK <br /> � vYwH�"� I _"Eledric _Gas_Other � "� I� ��/ �'� <br /> WORK DESCRIPTION <br /> �G{t.lilvV I'G'Sl� t j�p�tf`S � k?1�0y1� <br /> PLUiWBING �,/ �q MECHAMICAL p/ �.. <br /> NO. TYPE OF FlXTURE OR TEM NO. TYPE OF FIXTURE OR REM <br /> Toilet A/C—air handl;ng units <br /> — getrytub Faced air syslems <br /> Lovatory(wash basin) _ .^�as piping <br /> Shower Water heater <br /> FGtchon slnk 8 disposal Gas fireplace <br /> Dish•vashe� Gas rango <br /> Clothes washer Clothos dryer <br /> Leundry tray Range hood <br /> Sink(servir,�rlrtapletc.) Exhaust fan <br /> Backllow nreventer Heat p�mp <br /> Urinal Unit treater <br /> � Drinking l�ountain Boiler <br /> Floor drain Retrigerati�n <br /> Grease trap Woodstovo <br /> Roof 6rains Other <br /> Other <br /> CfTY OF EVEftEfT LOCAL SALES TAX CODE IS 3105 <br /> I hereby coritify that I have road and examined this applicatlon and knaw the same to be true and correct. All prwisions of laws and <br /> ordin gwemin�this type of wwk will be complied with whether spedfied herein or not.The granting o(a pertnit does not presume <br /> to give au 'ty to violal�or cancel tlie provision o(any other state or local law raguiatlng construction or ttw periomiance ot <br /> mnsWdion. �at m auUwrizod by the owner ot this proparry to perfonn the work for which application is made and I comply with the <br /> Stale ContraG9t CW end 296200 WAC. <br /> � z� <br /> Signat�re o nvactorl thorizeA Agent Da �'.� <br />