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PERMIT APPLICATION <br /> CITY OF EVERETT PE'RMIT SERYICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 42�257-8857-www.everettwa.orq <br /> APPLiCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ' .�3�'-O �] <br /> SIIE ADDRESS L,, Q PARCEL T�AqX I.D.f nPERM(T A <br /> 2.�2C7 1.ATG �'FJ � 2�5 c- f CC9�� VG �� -1 -C=�7 <br /> LE LOTNO BIOCK TRACT (�� ,{� <br /> DESC. q Y16,Q�'? ��vP�1/ �K. 17 <br /> py,M� ADDRESS Cff'f21P PHOME <br /> h l�vf.�/ (�c4ti �f�ety(ti'hi� U.C. I"1(o`f' �,"ctM pK.�o �wc..�Sa.� Oit�,�A- <br /> TENANT N E COHTACT FOR PERMR PHONE <br /> ��k �Gt(X�t►'"[�^,'�� I� hllwa,Jue. �dYw�lc. � • 2c� �?��(dl�- <br /> Ca� M�G�UY, �J�SD Ig��� �(JG �`I� �nCfTY/aP PHONE <br /> C�*�G��, .7�`'," 4�i�1t� w— �pqM� ��'�� „�Iv <br /> �wi. <br /> USE OF BUILUIN/� I —� /HEAT SOURCE OfJ7RACT PRICE OF W6R�K <br /> vElectric Gas_Other � �// • � <br /> WORK DESCRIPTION <br /> pcfr,vtc�v rz-s�d.u� t �(rs � Err(�t�s <br /> PLUMBING �,/ �o, MECHANICAL �I h. <br /> NO. TYPE OF FlXTURE OR fiEM NO. TYPE OF FIXTURE OR fTEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basfn) Gas plping <br /> Showor Water heater <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwashar Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unil heater <br /> Drinkinc�Fountaln Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstwe <br /> Roof d�ains Other <br /> Other <br /> Cf1Y OF EVEREff LOCAL SALES TA%CODE IS 7105 <br /> I hereby ceritify that I havo read and examine�d this applicatlon and know the same to be We and cortecl. AII provisions ot laws and <br /> ordin goveming this tyye of woric wili be complied with wt�ether specified herein or nol.The grantiig oi a pertnit does not prosume <br /> to give a ry to violate or cancel Ure provisiori ot any other state or local law regulaUng construdion or the pe�formance of <br /> consWctlon. at m auth�rized by the owner of this pmparty to perfortn the wafc tor whidi applicatlon is made and I compty with tlio <br /> State Contrad CW and 296200 WAC. <br /> ? Z/ V � <br /> Siqnature o nvaclorl,4 thorized Ageni Da � <br /> ;z <br />