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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE i T, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everellwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> � ° -}3 �7 <br /> SITE ADDRESS PARCEL TAl(I.D.# I PERMIT# <br /> 3� <br /> 5_Z�—`CA J�N b_ l��_ --------�1�_v?Lf1 —�'�f <br /> LEGAI. LOT NO. I BLOCK TRACT OR SUBDIVISION 7 <br /> DFSCI <br /> �'"-------- �-�- -� —-- -- �--- ADDRE55--�------ CITY/ZIP "---- PHONE �- <br /> OW ER <br /> _a. �c _ ��_._ll �_�_�L36�L-�►'�A° S __�(e�,�"c.�A�aa.)z --- <br /> TC:NANT�N�tE CONTACT FOR PERMIT PHONF <br /> E-MAIL <br /> .. __ _ __ .. . __ _____.__—_7�b�h�§__ _. ____.__.____. _--CIlY/2(P--�-FTOfd@__--__.--_ <br /> �TFACTOR <br /> �7� n n `/ /� � <br /> CONiR.LICENSEp (. 'l�l�l,�� / l�`-'L� <br /> __ _ _.__ . ._ . _. . ._. . .._ __. _ .__—__ <br /> ._ —_ __. _—__ _. __ ..__ —__.—_...__—_. ____—__ <br /> USE OF OUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Llrr.hie G:�s l)Ihrr <br /> —____ _ . - . .__._. _ ___. _ <br /> WOkK D[�CRIPTION <br /> . . ..- - -�------ - -----------.. . <br /> PLUMBING MECHANICAL <br /> NO. TYP[OF fIXTURE OR ITEM NO. TYPE OF FIRTURE OR ITEM <br /> -- ludot �-� ------ � - -- — -A�C-airhanAlinpunils ------------.. I <br /> _.._- f3alhluli _� Forced nir systems <br /> Lerva�ory (�vash bnsin) _ Gas pipfnp i <br /> � Shewer S' N'ater henlur � <br /> Kitchen smV..8 disposnl _� Gas lireplace ' <br /> --- Dishwasher __ Gas ran�o <br /> Cbthes washer � Clothes dryer <br /> -�--�� Walenc�ater _ Ranqehood <br /> Sink (servicelbadnrp�etc.) Exhausl lan <br /> --��- [3nckllow preventcr _-- Hcat pump <br /> Urmal .___ Unit heatr.r <br /> Drinkin� Founl�in __ Boiler <br /> Floor drain __ Refrigeralion <br /> ..-- Grease tmp _._- Woodslove <br /> Roof drains _. Other. ---- <br /> -- Othr.r — --- — <br /> CI7Y OF EVERETi LOCAL SALES TAX CODE IS J105 �I <br /> I hereby c�ritil�- lhat I have m:id and eaamined Ihis applicahon and knov�Ihe sarne lo be Iruo and corrod All provisions ol Inws and i <br /> ordinar,es c�ovi�rning this I�pc�ol worV,will L•e cumplicd�sith whelher sPocdlnd horcin or not.The yranling ol a pennit does not presumc <br /> lo glvu nuthordy In viulnL�ur emcel�he provision ol any olhur s�.�le in lucdl L�c:reyulaling�:onslructinn nr tho pnrlormance ul i <br /> construdion. Thnt I an :wlhorizcA by lho owner of Ihis �,roprrty to porl��nn thr��,�,rF. Inr v:hi,�.h applicalion Is modc nnd I comply with the ', <br /> S�ate Contr;iclorti t mt 1H.' 7 RCN and 'J_96.200 WAC. � <br /> � z a� <br /> -JcC _ /°� � — ' <br /> Si9nalurc !.+nri. ��i ha �r'�ulhurized Agenl--� -- �atr� <br /> � <br />