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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 96201 <br /> 425-257-8010- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I Z—I 9-Q'� <br /> SITE ADf1RESS PARCEL TA%I.D.M PERMIT N <br /> , �= • �.cr. � � , � /j �-- �! '- '' Ily �f;�L�� �il�� ��v,51� � 111j _ <br /> LEGA LOT NO. BLOCK TRACT OH SUBDIVISION 1 <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> L- �• ' , f ! � �.f _ <br /> TENANT NMIE CONTACT FOR PERMIT PHONE '� ��, l ],Z -�� �+� <br /> G� �.�n ��,� ��� .� : , �i - �� �`�rr' � ��� EMAIL ' ^ � - ':u�.w� �r r �,cp,r� <br /> ' , �=. � ,- . - � <br /> �r'� Mu:�I,�u .nL. />C ./`�/7 �t•,�on , ���5 � ���4 3�2 -L53Z <br /> CONI'H.LICENSE N !� 1� 1� <br /> USE OF BUILDING � HEAT SOURCE CONTflACT PRICE OF WORK <br /> Electric Gas Other � U ��� <br /> WORKDESCRIPTION��` �+� ar<< �o,,, -� � (}S ��u.n6, . GP��-- ��^ � � ��^ < S, ti; �,., <br /> / ( � n ^/� <br /> (�� Jri�. � �� \' ��ii� 5 n� �l wL �/ �'Ltc �/ Y� I �i�♦ 1-• (C_ `)/9p� ��� <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TVPE Of FI%TURE OR ITEM NO. TVPE OF FI%TURE OR ITEM <br /> ��( Toilei A/C-air handling units <br /> Balhtuo Forced air systAms <br /> ,[� Lava�ory(wash nasln) Gas piping <br /> Shower Waler haater <br /> .� KOchen sinh 8 disposal Gas lireplace <br /> Dishwasher Gasrange <br /> Clothas wa�her Clothus dryer <br /> I Water heator Range hood <br /> � Sink�eerviceiba��mop'elc.) E-Khaus�lan <br /> Backflow pre�•anler Heal pump <br /> YUnnai Uni�heatar <br /> Drinkmg Fountmn Boilei <br /> i Floor Arain Refrigeration <br /> Grease Irap Woodslove <br /> Rool drains Other _ <br /> O�hcr <br /> CIl V Of EVERETT LOCAL SALES TAX COUE I`3 3105 <br /> I hereby centdy that I have road an0 ezammed Ihis applicahon and know Ihe same to be Vue antl correct. All provisions ot laws end <br /> ordinacus�overmng ihls rype ol work wdl be compliod wi�h whelher specdied horein or no�. f ho gran6ng ol a pormit does not prosume <br /> to gwu aulhonty to violate or cencel the pro•ds�on o1 any othei state or lou�l law regulating construction or the pedorma^ce of <br /> consUuction. That I am authorized by�he owner of�his propeAy�o periorm ihe work for v,hich apnlicat�on is made�nd I comply with the <br /> State ConVac�ors Law 1827 RCW and 296200 WAC. <br /> ; '--' � �;' � --�- =������ �.; <br /> S�ynatwc o OwncU IiactonAuthorized7�gont / �e <br /> � � i <br /> I ... _ ___ __ _ _-___...__—___ ---_.__— <br />