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( <br /> PERMIT APPLICATION <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 <br /> SI7E ADDRESS EY FG:'r'� PARCEL TAX I.D.t PERMIT <br /> /`�°'� A N r_'w� t� ��� tir� 9�«i US/Z <br /> LEGAL LOT N0. BLOCK TRACT OR SUBD;VISION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PFiONE <br /> �J �N D F,� ��. (�i�o��� l�i� A �f Eu,;-r Av� fv Eu:-rT q�«� �i1S-28o l�G9 <br /> iENANTNAME/j CONTACTFORPERMIT PHONE <br /> C V�l�y IJ7 S�l IE U E-MAIL <br /> �N�rla7� l t, g,.�'Si��.+�, i �3oX 71 Z v✓t�..t.r.tv,(!� L✓/1?Gu 6 r s 7t�d-t <br /> coNrra.uceNsea w�= S '� � �'S 965 � 3 <br /> (��23 � <br /> USE OF BUILDING HEAT SOURCE QQNTRACT PRICE OF WORK <br /> �V <br /> _Electric _Gas_Other I,S G� <br /> WORK DESCRIPTION <br /> � ' <br /> ��Uw�c.�ro t' �i: �v�`pfc�sr.r S'�S'�'' <br /> r�By{�_ !f !-EvaJ �'o::�l� I-c �1�t,�;.l.,�vy: n:.• <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIxTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel PJC—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kitchen sink R disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(servicelbar/mop/etc.) `� Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinkinc� Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roo(drains Other <br /> Other <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify lhal I have read and examined this application and know the same lo be lrue and cortect. All provisions of laws and <br /> ordinaces goverr�ing ihis rype of work will be complied wilh whether spocitied herein or nol.The granting of a pertnil does not presume <br /> lo give a thoi y t violate r, cel Ihe provision of any olher state or local law regulaling construction or the performance of <br /> cons clio h I i au i d by Ihe owner of Ihis property to pertorm the work tor which application is made and I comply with the <br /> SI e Conlr t s La 18 CW and 296.200 WAC. <br /> �' /�J— U � <br /> Si lure of i on r,clor/Authorized A�ent Date <br /> '�� <br />