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1 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERET?, WA 98201 <br /> I 425•257•8810— FAX 425-257-8857—www.evere ttwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T04 PM G —�I�13 I <br /> SITE ADDRESS PARCEL TAX I.D.M PERMIT M <br /> a c�r� � s ooaoa � - az <br /> LEGAL LOT ND. Bl9CK iHACT DR SUBDIVISION� <br /> OESC <br /> 0 NEH � RE95 CI7Y21V PHONE <br /> nP �, .� n��.�h,►�.� ��.. � �- 3� � . �-�. <br /> TENANT NAME `C,,ONT�CT FOR PE(R�M�I7 PNONE :�0� �a�� �I1`OO <br /> I.�K�(Y1.� i (t7 Cy Ci1lA�D.�I�1 B�MAI�JGU YY1A<�i:1Ji� .YU'10..I1 <br /> � OR .��� • r�A D R 9 ('� S � CI YILIP 1 I PMO . . <br /> ' '"\ �L �ri�.y�Tt-L <br /> �1 F�I lr.F; �Cl� .��1�c �1 oC� �'.c r <br /> CONTR.IICEN3E1 �CL�1,���.�, �� I <br /> USE OF OUII[]ING HEAT SOURCG NTRACT PRICE OF WORK <br /> �� _Electric,�as._Other � �aq � <br /> WORK DC�SCRIPTION <br /> U6/i�JY�c�- �-xti �t �� q a S r r�t c.e� <br /> PLUMBINO MECHANICA <br /> N0. 7YPE Oi FIXTURE OR ITEN N0. TVAE Of-F�XIURE OR ITEM <br /> lo�let AIC–air hantlliny unds � <br /> i ^ 6alhtub � Fo�ced av systems � <br /> ^ Levatory(wnsh besm) � Gas pipmg <br /> _ Shower Weter heeter <br /> Kitchen�ink fl disposal Gas fireplace <br /> � Dishwaeher ~ Gas renge � <br /> ~ Clo�hes washer � C�othes dryer <br /> � Woter hester Range�ood <br /> ^ Sink(tervice/b�dmopletC) _ E�aUsl fan <br /> ~ BackAow Dreventer Heat pump <br /> _ Unnai ` Unit neater <br /> IDnnRing FOuntain ` 6oiler <br /> _ Floardroin � ReGigoraticn <br /> � �_ Grease trap N/oodsiove <br /> I _ Ronf�lrams _ ` <br /> ^ Oliier � Othar <br /> I —' � <br /> IL17Y Of EVERETT LOCAL LqlE3 T4K COoE IS]105 <br /> I hereby tendy thnt I have reatl antl exeminetl this applicalion antl know the Seme to be true and corrett. All provisions of I2wy ana <br /> cry�nances governing this typ¢of work will be cnm tie with whether s cifed herein or nol. Tha renhn of I <br /> D d Pe 8 9 8 permll due;not presume <br /> M grve authon,y tc vmlate or canxl Ihe provisior ol any other slate or local I�w regulehng constroct�on or Ihe peAormance of <br /> Con9tt Chnn Thit I am Buthorix d by fhe own¢r ol th�y propErty fo pertorm ihQ wprk fOt whiGh epplic.ati0n ic rtl8de end I�Omply wdh the <br /> Sfate onlrectors Lew 1B 27 end 29 ,200 WqC <br /> � ^ <br /> 51 Btum of �eNContrBtt rlAu onzpd Agent p ��� <br /> i <br /> "`—�..-------�— � ��J <br />