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i '� <br /> 1 __ ._ _. __ i <br /> � PERMI�T APPLICATION <br /> CITY OF EVER�TT PERNlIT SERVICES <br /> I 3200 CEDAR STREET, EV[RETf, WA 98201 <br /> I 425-257-8810-FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FRQM 8 AM TO d PM �� _�3 �D C� l <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT il -� _.�/�{ . <br /> �Y1C i <br /> �j(7 (/I ���Yr1,r}'I.f/'Z '1 GU495�U13�Zbl�U ) _ ___. ���.� <br /> L[GAL LOTNO. BLOCK TRACT <br /> DESC. - <br /> �ER ADDRESS� CITYZP PHONE t��C,3j-�.(,�zb <br /> ' 51�11�� �� � �-1 '" '° '�`�� Al� �l���/A 9�1Z� <br /> p�< n �v�c�. <br /> IiENANTNAME CONTACTFORPERMI7 PNDN[ <br /> �� 4�z7 3�7-��2��5. <br /> �I CONtRACTOR ADDRE39 --- CITYIZIP PHONE --�—�'---- <br /> � <br /> �i CONTR.LICENSEp � <br /> I USE OF BUILDING HEAT SOUf2CE CONTRACT PRICE OF�lJORK <br /> , Ele�tnc _Gas_Otner � _t��- -- <br /> WORK DESCRIF'TION � , <br /> � /L�/I?UGCG� ----------- <br /> ------- PLUNIRING ---- ---- ------------- MEGHANIC<�L <br /> j NO. TYPE OF FI%TURE Of.�TEM NO. TYPE OF I°IriTURE OR I7EM i <br /> IToilet —�----- — qiC-uir hnndhng umts -------------- I <br /> I � f3athtub _ Forcetl air sysfems <br /> � Z Lavatory(vvash Aasn� _ Gas pipiog <br /> � Shower _ VJater healer � <br /> � ICdchen sink 8 tlisoesal _ Gas fireplece . <br /> Dishwash��r _ Gas rznge <br /> � Clothes washer __ Clothes dryer � <br /> _ Laundry Iray Range hood <br /> Sink(servlce;badmopietc.) � Ezhaust fan . <br /> Backflow preventer Heat pump <br /> Unnal Unit heater <br /> _ Onnking Fountain __ Boiler . <br /> Floordram _ Fefnc�eral�on � <br /> Grease trep _._ Vdoodslove <br /> Roof drains __ Oiher_, _ <br /> Other-- — -- ----------- <br /> '� CITV OF EVERETT LOCAlSALFS TA%CO�E IS 7106 __�_ <br /> I hereby centify that i have read and examinetl this applla�iion and ki�rnv the same to be true and correct. All provisinns ct lews antl ! <br /> ordinaces governing this type of work will be con��plied with r�hether speatied hercin or not The grarGng ot a perm�t does i�o:presarr�e <br /> � to give authonry to violate or cancel the Fwvision of any other,tate or local law regulatinc�construction or the peAormance of <br /> Iconshuption That I am authorizeC hy lhe owner of this property to EwAcrm tPe work fo��Much�pplication is made and�co-nplq��th the ��� <br /> ! Stat C n lactors Law 8: N.nd 296 200 WAC � <br /> , , � � � ,� , <br /> ��I i�nature o Ovmer ntra tor/AuthorizeC Agent � ��'��' <br /> � '/"� � <br /> � _ _. ._ .� <br />