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� � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVER[TT, WA 98201 <br /> 425-?_57-8810— 1=AX 425-257-8857—w�nnv.everettwa.or9 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> S TE ADDRE33 PqRCEI TAX I.D.M PERMIT k <br /> L� � ����a i � I w� � z ► Z-o� <br /> L[GA LOT NO. �LOCN TRAC7 OR Sl1RDIV1510N� I <br /> UESC <br /> OWNER AODHE55 GTYlZIP vHONE <br /> �0.n C� p C�{l � �A�- � .`,�`�_G�.5�-2� <br /> TENANT NAME CONTACiFOR PERMIT PHONE�D4, �a�+ �.0;�(1 <br /> ��Y1•i t C� C.7�-A1 EIAAII�IY�.+L N�� 'I.YID '1 <br /> �=0N7RAG70R .�yV„� •�;.�/�p ADDRE39 � �� I GI7Y21P PHCNE � . <br /> -� QL �4-4�-c.. ,1 <br /> CONTR.LICENSE4 �6��G'rG �� �~� � � �,T <br /> 8��.�.X,��a-�� <br /> U9E OF 6UILDING HEAT SOURCE I CON7RACT pRICE OF WORK <br /> �� � _Elsctric _Gas�7fner � ��O <br /> �WORK D S�Ri P1TION� � � ^ ,,, ^ � <br /> �'1�, � a � �iv s r�ic.� u.� ► � a s ;�t ' w <br /> PLUMBING MECWANICAL <br /> ND. TYCE OF FIXNRE OR ITCM NO. TYPE OF FI%TURE OR IT[M <br /> _ loilet NG-eir handUnp units � <br /> _ Bathtub ,� Fora±dairsystAms <br /> __ lavatory(wash besin) � ras o�pmg <br /> Sbower 'JJafir heater <br /> _ K�tcban sink 8 d�.sposal Gas firep!aca <br /> D�sh+vashcr ^ Gasrange <br /> Cbthes wnshr Clothes dryer <br /> _ Water heater _ Ranpe hood <br /> _ Smk(,crvlceA�as/mopletc.) Exhnust fan <br /> 13ockfiow prevontpr � Hnal pumo <br /> i Unn;al � Uni;hnalcr <br /> _ �nnkinp Pounlaln 8onei <br /> _ Flooi drain ` P.ofn�eratiUn <br /> Grcese trnp Vdood5lovr. <br /> Rocf dralns ^ Othor <br /> � Other —� <br /> CITY OF NER�TT LOCAL SALES TN(COC�IS J10G <br /> I nereby certiy that I have read and exam�ned this application ard know the same to bo true and cormd. All provisions of lows and <br /> ordinancec governing this ryue of wnr�will he complicd w:th whether specified heroin cr not. The granhnp of a pnrmit does not pvvsume <br /> to glve pufhonty to v�olnta o�Canccl thr prov�slon of any Mher slnU�of Iewl law reyulating cortsln�cHon ef the perlormanCe 0f <br /> conn cnon.Thai I am authoriz d by the owner of this properry to perform Uie vmrk lorwhich apolicafion is mado and I comply wlth the <br /> �`(aw .anlra�tor,Law 1027 end 2 2001VAC. r <br /> � alurw o� wner�CunUadeUqu otlzetl Agent � q�� <br />