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� <br /> - --- -+ - - ---� <br /> � PERMIT APPLICATION <br /> CITY OF EVERETi� PERMIT SERVICES <br /> 3200 CEDAR STREE'i, EV[RETT,WA 98207 <br /> � ' ' 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.N �ERMIT t <br /> r <br /> ,, � � �,.� ����,��.� ,�„� �iJ �' 27 <br /> LCGAL LOTNO. OLOCK TRACT <br /> DCSC <br /> OWNER A�URESS CITYRIP PHONE <br /> i , <br /> ri <br /> IENANTNAME CJNT4CTFORPFRMIT PHONE <br /> . '�( a "1`��i ����44 <br /> ._,. � r� �('� Lir-,�i� �.f Lat.c. -"�-:.,>.,_ �,�..yl ��(Vnn,�.� �1�; ��.i�\ <br /> CONTRACTOR �ti���,�,� `�.,,. � .�,�r+, ADDRESS ��,�Lr '1i� CITY2IP PHONE <br /> ..1���� .1.�['+._` ���» <br /> CONTR.UCENSE R �� / l/J ' <br /> 4�1i ,r�FSc�-77R,� ll �T � ',l.c ����`; `�'I4�1 <br /> USE OF BUILDING I — HEAT SOURCF I CONTRACT PRICE OF WORK <br /> '� n <br /> Eleclric Gas Other �f[,�j':-j�- <br /> WORK DESCRIPTION <br /> L`_L,��-, ��.. . r... I_ � t :i ,_.. �.��.�,�: l . , <br /> ,�� . ii ,: . . . <br /> PLUMBING MECHANICAL <br /> NO. � TYPE OF FIXTURE OR ITEM N0. TYPE OF FU(TURE OF'EM <br /> ___ Toilc� __ A/C-air handiing units <br /> _ Dalhlub _ ForceA eir syslems <br /> __ Lavalory(wash basin) __ Gas piping <br /> __ _ Showcr Water heater <br /> ___ Kitchen sink d disposol Gas froplaco � <br /> ___ Dishwasher __f__ Gasrange ' <br /> _ __ Clothes washer Clothes dryor . � � <br /> ____ Lnundrytray _1__ Rangehood • },: <br /> ___ Sink(servicefbarlmopletc.) __�_ [xhausl fan �� <br /> __ 6ackllow prevr.nter __ Heal pump . � ��� �� <br /> _ _ Urinal Unit heater , � . <br /> __ _ D�inkingFounlain _ �oiler � � � <br /> _ Floar drain _ Re(rigerelion 1 <br /> _ Grcase Irap Woodslove . <br /> . Rool drains Othor <br /> Other -- - <br /> qTV OF EVERETT LOCAL SALES TAl(CODE IS N05 <br /> I heroby contily thal I hnve iead and examined Ihic opplication end know the sama to be Vue and correcl. All provisions ol laws end <br /> ordinacr,s goveming�his lype of work will be complied wilh whMher specified herein or nnt.Tho grunting ol a permil doos nol prosume <br /> to give nulhorily lo violate or cancel Ihe provision ol uny olher slale or locnl law regulaling conslruc�ion or ihe perlormance ol <br /> cons�niclion.Tha� I am nulhorized by Oia owner o��his property�o pedorm�he work lor which appliwtion is made and I comply wilh ihe <br /> Slale CoNraclors L�w 1827 RCW and 296200 WAC. <br /> ���_;+\- � c=- _ - �:-I �` � IL�51 <br /> Sic�nature ol OwnedCoNratlorlAitlhorvr,A Agenl Da�e <br />