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ii -- �, -�6 <br /> � � PERMIT APPLIGATION � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 4?5-257-8f357 -www.everettwa.org <br /> APPLICATIOPIS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE A DRESS 1 PARCEL TAX I.D.# PERMIT k <br /> �I._S ECrtr►►�i � ��'p 7£�'��D��Can�C�Ztx� ' � So <br /> LEGAL LOT NO. BLOCK TRACT - - —_-- <br /> DESC. <br /> WNER ADDRESS CITYIZIP PMONE <br /> ��,� C..�M� �-�+� v Ql�� E C.4r���,�'a ��r- <br /> TENANTNAME C NTACTFORPERMIT PHONE <br /> �G� cF l e��/4�r �s �t'�3 -��s� <br /> CpNTRACTOR A�DP,ES CIry 21P PHOrE <br /> /t�VA+��'�D �+c>c� ���r�=n��..� 1� 7�P� 1�1�1�,�,�r ti.0 6C�Avy� 4zs ��i � <br /> CONTR UCE E M ���z <br /> A�►'�.��i��� <br /> USE OF EUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��M� �L� _Elaclric _Gas__Other �.�(C�j <br /> iI c v <br /> WORK DES�CRIPTIO � 1 I_- <br /> -�itl-'�i/Kt � �L�E7�7� �a.� NEW l.�F-�ilE �-� � L�7P. lE..r�-�� IN �'-p/�WL 5(�{cE <br /> f <br /> i�rw �i�fu'E <br /> — PLUM8ING MECHANICAL <br /> NO. TVP[OF FIXTUR[OR ITFM 170. TVPE Of FIXTURE OR ITEh1 <br /> Toilet NC—air handliny units <br /> OathWb _ Forced air sys�ems <br /> � --- Lavatnry hvash hasin) . . Gns pipin9 <br /> .. . . Showr.r __ Waterheatcr <br /> IKi�chen sink& d�spos�il _ Gas Orepl�ca <br /> Dishwasher _____ Gas rtm�r, <br /> i _ Clothes washer _ Clolhes dryc�r <br /> , Waler hualer _ Ran�e hood <br /> �' -- SinA(scrvice'liarlmo��!ul�:.l __ [xhaust fan <br /> � Bar.A(low preveNer --- Heal pump <br /> � Urinal Unit hcaler <br /> Drinkinc7 f nunt:iin _ Boiler <br /> � Floor drain _ Re4ic�eration <br /> I _ Greasc hnp __ WooAstove <br /> Rool dr�in.; __ Olhcr. --_— <br /> Olher — ---- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> i !�,r�r-�!��•;ceritily Ih:it I hivo reacl �nd evamineJ this appt',ca6cr,anJ 4.now Ihu saine lo be true and conaet. All provisions ol laws and <br /> urd�races guw:minc7 this lype of aior6 will be complied with wh?Iher specified herein or noL The qrentin9 of a pennit does not presume <br /> j l0 9�vo aulhorily lo violyde or canr,��l ihr,prnvision of any other s121e or Incal law m�ulalinp construclion or�h�pertormanca o( <br /> i.oastruclion. That I am aulhorized by Ihe ownr,r ol ihis pmperty lo pertorm Ihe work tor which epplication is made and I comply willi the <br /> SIatM�Con clors�-L-a7w—1-827 kCVJ�id 29G.200 WAC. <br /> C r. �'� I " t /��l�r(�� <br /> Signalure o�OwnnriConlractodAu�horized Agenl Da�e <br />