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�l O� � <br /> , <br /> �f PERMIT APPLICATION � <br /> � CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR S I RCL T. EVERti �, WA 98201 <br /> 425-257-8810- FAX 47`i 751 8857 - �+n+nv everettwa org <br /> i ; <br /> APPLICATIONS AHt �CCL'Pi[D FROM B AM TO 4 PM � <br /> I -----____. -- -- --- -- — ---- — -- -- --- - <br /> � SITE ADDRESS ' PnRCCI.TA% LD. q �� PERMIT p � I <br /> , z_r��_�Q�, s�- ___— ��s��yvv ��� Qo� _ _ _.� V� I�((�C�_o3 <br /> i�cni. �or No oi.oc�ran�:i <br /> oFsc I <br /> - -- -- _ -- --------- ----- <br /> OWNER ADInu�S� CItYILP PHONE <br /> ; �a� `�NS___���8 ��a!,_ S/ --�,�t:�Y_ wA �4�>zsz i�/� _ 'I <br /> � TENANTNAME CONIni:110NPfRMIT PHONE <br /> II I <br /> 'I _—_- -_—_ ___ <br /> - .__._—'—__ _____._ __.__. __ ..__.___.__._—__--_—.._._._____—. '� <br /> CONTRACTOR � � AUU�,: Sti CITY�21P PHONE <br /> /�//ylci•7 frif �S//�'f S /.f'ic3 ifiEG� 57 �c 1�� /�/a.i.�r/l.�i 4Y'i 88�7GTv <br /> CONTR. LI�ENSE N� ����� i <br /> I �liL1<�`L.L=l�Y(7 y-___—.---' .._ '._. __—_—___ I <br /> � USE OF BUILDING i1Lnf SOUNCE CONTRACT PRICE OF WORK <br /> � � _Ficctrc _Gas_ Othe� O ��� i <br /> ----- ---- — ----____.. _---- — . ..._ . .. _---- ---- <br /> I WORK DESCRIPTION I <br /> I <br /> -- --�-. __ . _- ----�-- <br /> PLUMBING I MECHANICAL <br /> • N0. TVPEbF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ItEM <br /> _. —_—__- _ __ __ ._. _ . _ —. _.._ __.. .. _ _. . _ __._— � <br /> __ To�le� j A:'C-air handhrg unds <br /> __ Bathtub Forcetl air Sy5�em5 I <br /> _ Lavalory�wash Gas�n) _ Gas pip�ng <br /> _ Shower Woter heater I <br /> Kdchen smk R d�spos � Gas fireplace <br /> I . Dishwasher _ Gas rangr <br /> CloUies washer __ Clolhes Aryar <br /> _—. .I�undry IraY ._ Range hooA <br /> .. tiink lservir.� ar/mop/etc) C.haus�l;�n /, /, f n � <br /> _ F�a;MOnw evenler / I fral pump �,r.r ni S 5 ffi.r /a.�. <br /> l lrinal t Init hcater <br /> Drui �q(bunlain Roi!r.r ��v�-�-�� <br /> I _ . f�dram .. Hrin9eration <br /> C�reasc tiap Woodstove <br /> ,�Roof drains Othcr <br /> --� Otner -- . - �-- <br /> I <br /> I --- --- --�- <br /> ' CITV OF EVERL�l LOCAL SM f.5 TA%COUB IS]f05 <br /> I hereby cenhly that I have reaU and examined Ih�s applic�6nn anA Ynow the s�me In be true and cortect All provisions of laws anA <br /> orAmaGes goVemmg Ihis type o(work wtll be compheA v.iDi�•:i�ethcr Spi�u6cA hem�n ur nol The yranling ol a permd does not presume <br /> ro grve auttionty!aviolale or cancel Ihe p�ovi,on of any olhrr sta4t or inrai law re��ulalinq constiuchon or Ihc, pertormancc�nf <br /> construcnon That I am aul r�zed by the owner of th�s p��a�•���v i��I����Inmi tli��v.e�F,fur wh�ch apphcat�on�s made and I compiy with Ihe <br /> Stale Contractors La 1 .7 � and 296 200 WAC / <br /> �/-y/1 <br /> S�gnature o .d , nlr ctouAuthorized gent 11,�r�� <br /> _ . .. . ._ . . . _ . . _ _. . . _ _. _ ._ _ . . . . ._.. . . _ .. I <br /> �S d � ��9 /07 <br />