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. _ __ - -- - _ -- _ ._ <br /> _ � _ .- ---------- ---i <br /> PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREFT, EVERETT, WA 98201 <br /> I 425-257-8810- FAX 425-257-8857-www.evereltwa.org <br /> i <br /> I APPUCATIONS ARE ACCEPTED PROM B AM TO 4 PM - DEBIT 6 CREDIT CARDS ARE NOT ACCEPTED <br /> �', SI7E ADURESS PARCEL TAX I.D.N PERMITN <br /> �40/ Aa���R Rv� c�oc�//�j�nn�n/on �c�sGS-o �/ <br /> � IECAL LOTNO. BLOCI( TRACT <br /> I DESC. / I <br /> OWNER ADDRE55 CITY/ZIP PHONE <br /> RrcNAR� M��,r,er� �cai /��c�r�t H�� ,����rr,� 98aa3 �as=.�sa-�8c <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> SAM� I Rrcy�av /`9y�1-b�G �?S-QS;,� � yG�G <br /> CONTRACTOR D�vr,^ AUDRESS CITYI2IP PMONE <br /> r.�C <br /> ICON7R.LICENSE N <br /> IUSE OF BUILDING HEAT SOJNCE CONTRACT PRICE OF WORK <br /> Sr�(�L FA�►,,c�.Y Rwsmrw�� _E�e����� _�'Gas__Olher 7/J/iJ — <br /> � � <br /> WORK OESC(jIPTION <br /> .;C' � .r, ������rx�,� ,—c �tir;c���� N� - 79�z <br /> �?��' ;,� 1�l<<K /�rJr��r�-c:,, - S`�` <br /> PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIl(TURE OR REM <br /> I <br /> ' _ foilel NC � air handling unds <br /> � .__ Bathlub Forced av sys�ams <br /> I _ _ Lavalory(Nash 6asin) _ _ Gas piping <br /> � Shower Waler heater <br /> i j Kdchen sink 6�CRp�f�3F Gas fveplace <br /> I _� �ish��ashar Gas range <br /> ___ Clo;hes washer __ Clolhes dryer <br /> ._ Laundry Iray Range hwd <br /> I _ Sink(service/l>ar/mopletc.) __ Exhausl lan <br /> Baickflow prxvenler _ - Heal pump <br /> Unnal UNI hxater <br /> �,� Dnnking Founlain Boiler <br /> _ Floor Arain Reingeralion <br /> ; Greasa trep Woodstove <br /> '� __ Rool Arains O�her <br /> Othar — <br /> � -- --— - ------ - .... <br /> ._-- --------- ----- <br /> I ��— ---- -- -- ---— -- <br /> � I� CRY OF EVEREtt LOCAL SALES iAlf CODE IS 7105 <br /> i I he�eby cen4ly that I have read a�,d examined lhis applicatwn and know lhe same lo be true and conecl NI provisions ol laws and <br /> ; oMinaces governing this lype o:wo�k will bx complied wi�h whethnr specdied herein a nol.The gianling of a permil does rot presume <br /> �i to grva aulhonly lo vinlala nr cancel lhe piovision ol any olhei state or Ixal law regulaling cons�rucUon or lhe peMormanw ol <br /> conslruclion. 7hat I am aulnon[ed by Ihe ownxr of Ihis properly lo per�orm Ihe work la which applica6on is made and I comply with�he <br /> i Sl�le Conlractors Law 1tl.27 RCW and 296.200 WAC. <br /> � <br /> �_7����� s 0 s <br /> .� SignaWreolOwner/ConlraclorlAulhorizedAgxnt p 1e �(a <br /> � . . . . _.--� - ---_._. ----- __ ---- ------�---- - � <br />