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��e.��Q- �-{O-�?�---- - <br /> ' '-� P�MIT APPLICATI� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257•8810— FAX 425-257-8857 — www.2verettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �b-o a `"�U <br /> SITE ADDRESS PARCEL TAX I.D.p J PERMIT p <br /> 3� �4 ',� �oy ioda �ooaa� MitiOq - o� <br /> L[G� LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC <br /> OW4ER MDRESS CIIYIZIP PHONE <br /> $�oe.i_ n,.. uo�c�n7 "� nN-��. �e�z_Rg2�( 2D1�•7.�0•�(S"3� <br /> TENANT NAM CONTAf.T FOR PERMIT PNONE �6.Z�,lr S�,3D <br /> ��(�''-�y-+�J�G � E-MAI <br /> CONTRACTO�R�j — 1__ � POORESS � • CITYIZIP PNONE � <br /> N�IQCn�n� �llnOD 5.1� �.Q ,Stalt�.t �/� Z!/(eZSU�{fJ0 <br /> CONTR.LICENSE tl <br /> It�U4�PI 37�i IJ � ---- -- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ___Electric ___Gas Olher 1 I � ��3 <br /> WURK IPTION � � � � . S !L 0.SS <br /> ��-��.,� �- �te. 4�� .s�-��a. <br /> - PLUMBING MECHANICAL <br /> p, 1YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> —' _ _—__ _'_. _._ __ <br /> odet __ NC-air hanAl�ng units <br /> -- g. ���� Forcetl ah systems <br /> l�va (wash basin) Gas piping <br /> Showar Waler healer <br /> . Kdchon smk ispusal Gas hreplacc� <br /> � ____ Dishwa�hcr -- - G:is r;mye <br /> Clothes washer _. Clo�hn;drye� <br /> i __ Waler healer == P.angc hood <br /> Sink (servicclhadmop/r. . Exhaust fan <br /> i __ F3ackllow preventer __ Hcat Dump <br /> Unml Und hc��er <br /> I _ _ Unnkmg Foun � n _ Baler <br /> Ruor Arain __ Refrigcration y <br /> ..- — Grease .p Woodstoye� y ,� /� l�^"µ ` <br /> -- o�ner � nl/�-l" �1/ <br /> Ruol ains r•j " _, <br /> O .r � ---- <br /> -- - ---- ------- � � - <br /> -- - - � - -- � -- - -- <br /> ' � CITV OF EVERETT LOCAL SALES TA%COOE IS 7105 � J <br /> I herr.by cerlAy�lia� I have read and eznmmeA Ihis apphc.ahnn and know Ihe S;ime In be true and :nner.t All pruvisinns nf lawz and <br /> ardinances yoverning lhis type ol work wdl be cumphed with wheUwr specdied herein or nol The yranlinq ol a permit does not p�esume <br /> lo gi , ulhonty lo wolate or r.ancel Ihe prnvision o1 any olhcr state or locat law regulahng conslnir.tion or Ihe perlo�mance ol <br /> r.o druc n That : :�ulhonzed by Ihr nwn^r ol Itus properlY to pe rm tl r work lor whir.h app��cahnn is madr and I comply wdh ihe <br /> ;t; e Coi cac a . 7 ] CW and 2 . 0 WAC <br /> F <br /> - --- ,- -�-� ��z <br /> $iqrn �Ttre1.A . oNra ,or Aulhonr.ed Agenl �� P <br />