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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICE� <br /> 3200 CEDAR STREET, EVERETT,WA 98207 <br /> 425 257-8810-FAX 425-257-8857-www.everetiwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SITE ADDRESS PARCEL TA%I.D.# PERMIT# <br /> . ,. � �l . .. � ;�' - �� z <br /> c. 'x_ � �i � t ' �' � � f� - � .ti��_ i �.� „} - �4 _'l �,C� <br /> LEGAL LOT NO. BLOCK TR11CT OR SIIBDIVISION N <br /> DESC. "� � 7 L `�-�/cr. ���i i it_l �-�il L <br /> OWNER ADURESS CITY2IP Pr10NE <br /> 1 /� > � <br /> �`N�i �II,IYL /Lvili[•. . �1 ''i.'_ �Yui t' ��i �vif( i' �)7FL� '�Z� :i�i`� . j15�� <br /> TENANTNAME` CONTACT FOR PERMIT PNONE jl�j �� 2 '�i� -} <br /> z� - i <br /> � �1 j )iN(ZV'i' E-MNL ��t�i't,�CT��•�2�:_�LI <br /> ! I�lic ����;IL'��< ���v��bIIiiE�S /� .�?5 ' �� <br /> � I� ? ��i �...n lAv( �Kti '� /�'��Li .���.'. �L` <br /> CONTR.LICENSEM ���1��•�� ��,�;��_ ;� <br /> USE OF BUILDINC HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � �e lA(�iyC i���i1�'A l �� [Icctric __ Gas___O�har ��.�C�,C t : � <br /> WORK DESCRIPTION ?� ' �- <br /> ��ll`>�IJI.i(. __� �C Il�( i �c 1�� ��.�1M lA(.-i ��J��N1I�i C �� �'/ �NCi.. �_)���1� l� O �AiiflMi- I�h� l� <br /> 1� � (� <br /> iV� , i,, )�" � �� ri�,i�N� �r+�7Pr�l.� � �' �-1`-�.- L �' <br /> �h.' ���)I'IY � � �'l. �t CU ' 1 <br /> PLUMBING �I MECHANICAL ��f� <br /> NO. TVPE OF FIXIUHE OR ITEM I`�`�� NO. TVPE OF FIXTURE OR ITEM <br /> _______._--- — <br /> Toilet __ NC-air handhng units <br /> Bathtub _ __ Forced air systems <br /> . .-- Lavalory(wash basinl _--_- Gas Piping <br /> Showm _ Watcrticaler <br /> Kilchen sinh 8 disposal . , Gas lireplace <br /> � Dishwashcr ___ Gasmngc <br /> CloOics washcr _ Clothes drycr <br /> Watcn c�alcr __ Hanc�e hood <br /> Sink�scrvicab:v�mop�elcl __,. � [xhaus��an <br /> Dackltow picvenlm . __ Hca�pump <br /> Urinal ._. Unil healer <br /> Drinkin�Founlain ___ Doiler <br /> Floor drain __ Relrigcration <br /> Gensc trap -- Woodstovc <br /> I flool dranis ___ Othcr__ . _ . . <br /> Other <br /> I . ------ . _. . . ..-- <br /> � _. _. _�----- - .._._ _ _..__._ <br /> I __._-_ _ -- <br /> _-- ____ CITV OF EVEPETT LOCAL SALES TAX CODE IS 1105 <br /> ' I hereby caitily th,it I hnve read and e*amined Ihis appllca�ion and know the same�o be Ime and correcl. All provisions ot laws and <br /> ' ordinaces govenwx� Ihis Iype ol work will be complied wdh whelher specilied herein or not.The granOng ol.i permd does nol presumo <br /> ��, to qive authonty tn violale or cancel Iho provision ol any other slato or local law regulating con5trucUnn or Ihe perlonnanco of <br /> I conslruclion. Thai I am aulhorized by�he ownm ol this property lo peAonn Ihe work lor which apphcauon i,made and I eomply wilh the <br /> '� Slalc Conirac�ors Law 1027 RCW and 296.200 WAC. <br /> � - -- �'�.��.- � i ,, , � <br /> �, Signatu�e ncriCunVactoi'Aulhorized qen� aie <br /> � �� <br />