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� �RMIT APPLICATY�N -� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8657—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM l� '�-8� <br /> SITE ADDRESS �T� ` PARCEL iAX I.D.# PERMIT# <br /> 'J .,,,_S �, , l:�„/�� � /� v I�r��sU � — oc_IS <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PNONE <br /> ��(l �� IIJr". <br /> TENANT NAME / CO `CT FOR PERMIT r ��HONE�,�, G'� <br /> � � (•. �J � 1 <br /> �' r�t � � - � F__r� � r, ,7 jKr ( h"� � <br /> E-MAIL <br /> �QN"i/ ���Ii.L � �l1�� �.C;/'.% � . <br /> CONTR.L�CENSE M <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> 1�I�I,�) n/L./��'j ��F N L f _Eloclric _Gas_Olher '� �' � . <br /> �c.( r)a(7 <br /> WORK DESCRIPTION <br /> i � �i�_� /�� E � /I i- Ff- l�i , % ��f,_ P�i%= S T /�r LL ��� 7� <br /> �'n� ��/'- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TUHE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathlub Forced air systems <br /> Lavalory(wash basin) Gas pining <br /> Shower W ater healer <br /> Kitchen sink 8 disposal Gas lireplace <br /> Oishwashm _ Gas rango <br /> Cblhes washcr Clothos dryar <br /> Water hea�er Range hood <br /> Sink(servicelbadmop/olc J Exhaust(an <br /> �ackllow prevenler Heal pump <br /> Uiinal Unit haalor <br /> Diinking Founlain Boiter <br /> f-loor drain Refngeralion <br /> Greasc Irap Woodstove <br /> Roul dr�ins Olhor <br /> Olher <br /> CITY OF EVERETT IOCAL SALES TA7f COUE IS 7105 <br /> I hnreby r.eritify ihal I hava read and ezamined lhis�pplication and know Ihe same to be true and correct. All provisions ol laws and <br /> ordinaces guveming Ihis lype o1 work will be complied wi�h who�her specifiod heroin or noL The granling of a permi�does nol presume <br /> to give authority to violate or cancel tho provision o(any other slato or local law regulating construction or the padormanca of <br /> consiruclion. Thal I am aulhorized by ihe owner of ihis pruperty to portorm the work for which appllcatlon is made and 1 compty with ihe <br /> I �•ate�ac'��c:�is Law 1A 7 R W and 29G.200 WAC. <br /> <_n, w. i � �j.-��+.�"�� .�- � � �1n <br /> I <br /> Signature ol OwnodCon�rac�odAidhorizr.d Agent Dete I <br /> rL <br /> � ------- - ----- <br />