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.I�JI. Ij I��� L � � ' T�I�ili� • Yi0. Y'J�!: F L <br /> _...�— - <br /> PERMI �T APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAA STRFET, EV[R[TT, WA 98201 <br /> 425-257-8810- FAX 425-257•8657- vnvv+.c:-erettwa.org <br /> I APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7 � !��/Z <br /> SITE ADDI7ESS �e,�FQ,'�} PARCEL TAX I.D.tl pERMIT p <br /> i3i6 '�' sT �i5oa 9$z� � (''liad�-- o"�' <br /> LEGAL LUT NO. ULOCK TRACT OR SUBDIVISION q <br /> DESC <br /> O'1JNER ADDRESS CITV2IP PHONE I <br /> � R.�chard S i rx.i a:�►� so�.im e. N 25 25�1 l oo�l <br /> � TFNaNi N4fdE CONTACT FOR PEqM111T PHONE <br /> I ,DP,h9)je, 42`� 2SG �o�o�a �o <br /> e rna� <br /> I -�a„r"'�ra�crn f.l�, rY� 1n� ��4 i 5 Broc�w a.� 6�e.e,tt�9g zo�ZS 259 �66 <br /> � courn uc NSEa <br /> Crn �Oq�'�- <br /> USE OF BUIL�ING I — HEATSOURCE I CONTRAC7 PflICE OF WORK � <br /> �IacVic Gas Other 4�S4- � <br /> WORK DESCflIPTION <br /> �Y1S�A I� ��C..� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXiURE OR ITE1�1 tJO. TVPE OF FIIC iURE Oq ITEl.1 <br /> 7odot I NC-av handl�ng u�i15 <br /> _ 8athtub Fo�cea air systems <br /> _ Lavatory(wash basln) Gas pipind <br /> � Showor Watcr healor <br /> _ K�Ichen sink 8 disposal ^ Gas`iraplace <br /> _ D�Shwasher _ Gas rango I <br /> _ Clothes washer Clothes dryer <br /> Water hoaler Rnnp�hood <br /> � Slnk(service/badmop/elc.) Exhaust Ian <br /> Backtlow prr.venter Heal pwnp <br /> Urinal � Unii he�ler <br /> Drinkin�Pountain Boiior <br /> Floor drain Refrigeration <br /> _ Gruaselrap Woodslove <br /> Roof tlralns Othcr <br /> Other <br /> CITV OF EVERETT LOCAL SALL9 TAX CO�E IS J105 <br /> I hpreby CoriUly Ihal I have reatl and Cxdmin0d lhis applitali0n and know Ihe same 10 be Irur and COfreCt. All ptovlsionS of laws and <br /> ordinaCcs govorn�ng this type of work wlll be complied with wholhpr speci6etl hereln or not.Tho granfng of a pormd does not presume <br /> to pive eumorlry to violate or cancal Ihe provision ol any other state or local law repulaLng constructlon or the performanco ot <br /> construction. Thal I am aulhonzed by Ihe ownet of�his property to perfcrm the work for whlch applica;lon is rnade antl I comply wllh Ihe <br /> State Conlractors Law 1�27 RCW and 296.200 WAC. <br /> ��bb� �a��C 7 • 1 g �I 2- <br /> Sign�lura of O.vneriGom tovAulhorixetl�ga�t Pate � <br />