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r <br /> 7 <br /> ( i <br /> -- - -- ----- — — ---� <br /> PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> I APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE AD RE33 ��j� PARCEL TA%I.D.M F�RMI� <br /> �W• U•�,�� �`�s�414�.�n�oi�l��o '� � ��� n�� <br /> LEGAL LOTNO. BLOCK TRACT µ ` t-7 <br /> ��5�. ;,?�_ �....."a�ti r�y T ��_�S <br /> OWNER ADDRESS CTY21P PHONE 1 <br /> /� �� (yn -..nn. Ct�m��._rt�, ���r✓ <br /> ��1� Pn �n,� 10�3 r,�r rc'1t l�.�l '`�'1�ddcY; 3,�c '3.c;i- 6`eR0 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> ,L„� � 1�..�- C�� rc:les; 1-r..J� (.tlorn ��..� �.c36 �-t3 -/c��'� <br /> CONTR TOR 'f(j� ADDRESS CITY2IP PHONE <br /> � <br /> 5 �7p �/ I_��� <br /> CONTR.UCENSEt ���/�l��K� ( 7�L� <br /> �� i <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Eleclric _Gas_Other �'��'�����} <br /> WORKDESCRIPTION /?�n� f PXI 67� ���J ��Ip�%`'^�- �o�tcY ' ��=w` f�a++�/1ry, ��[IS'f/n�� <br /> ..Y\'��r,n.M1��.j ��� n.� •r2171�.�c�.�` r+��t�.. 7 . �IUC� ..CA� 11t.�.tin.� Y�r�J I <br /> Q�u1l�,n�,�+�.t" Gc•...b��,ct � or�. NX�..n.r)��� r�i.�5v..-�1 f���..'tfir�r•.v�. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Foiced ah systeins <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas 4replace <br /> Dishwasher Gas renge <br /> Clothes washer Clothes dryer <br /> Laundry Iray _ Range hood <br /> Sink(sernce�badmoplelr.J _ Exhaust lan <br /> Backllow pi.;venter _ Heat pump <br /> Unnal Unit heater <br /> Dnnking Fountam _ Boiler <br /> Floor dram Peingeralion <br /> Grrase trep _ Woodslove <br /> Roof drains Other <br /> Other — <br /> I CITY OF EVERETT LOCAL SALES TAX COOE IS 7106 <br /> II hereby centity that I have read and examined thls application and know the seme to be true and covecl. All provisions ol laws and <br /> �' ordinaces govemmg this type o1 wode will 6e comp6ed with whether epecified herem or not.The granting of e permit does not presume <br /> to gme authonty to violate or cancel Ihe provreion of any other stnte a lowl law regulating construdion or the perfonnance ol <br /> construction That I am uthonzed by the owner ot Ihis property W peAorm the work for which application is made and I comply with the <br /> Sta ontracrors law 827 RCW a 296200 WAC. <br /> �" L- � � � � �� � <br /> Sig Wre of Owrl r/ nt a torlAulho ed gent ate �� <br />