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1 <br /> � � ] <br /> —�6�� `,j(li, -� �'i� 1 — <br /> ' P�� MIT APPLICATION , <br /> CITY OF EVERETT PERMIT SERVICES <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 j <br /> I 425-257-8810 - FAX 425-257-8857 -www.everettwa.org , <br /> I � �, /-� , APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C./... � S`� � _ 'I <br /> d.1 � <br /> SITE AD RESS PARCEL TAX�I.�D�..k 1PERMIfT-�a � <br /> � —�'- -r � - _�� I� � lJGlil i lk(i � ,c� �v� d�� I� <br /> LEGAL LOT NO. BLOCK TRAL'T i <br /> DESC <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> � <br /> �Or-�'4�-' �v�Xt-(�" i�U I�x �'�4 tu ��tF W IA- Ll � s�(o <br /> TENA T NAME I CONTACT FO PERMIT PHONE <br /> � <br /> �1, ', 11,� r ��� � 11'D�l �vu�tl�n �r �t'e-�- �x'r�n C�de,l�v�. � <br /> CONTRACTOR•, � ADDRE55 CITY/ZIP PHONE ��• <br /> �.C2ir� G��/�,�i�-� 2t� 2- 1.��d�s�vr�� 733 �rSZ. <br /> i CONTR.LICENSE# }- /,�n y�`' V� '1 ,�Q� [J�7 ' <br /> �GL�TITT/��t���� ��� I �Iv'��• \ WT� ICIG�L�O <br /> USE OF BUILDING /� HEAT S`OURCE CONTRACT PRICE OF WORK <br /> v Electnc J Gas_Other ��31 ���0 '�,(J _ <br /> WORKDESCRIPTION I���C � PLUMB�AIC7 �R � <br /> l7 �3oQrw,dsN F,ec�urY I <br /> iPLUMBING MECHANICAL <br /> N0. NPE OF FIXTURE OR ITEM Np, TypE OF FIXTURE OR ITEM <br /> � Toilel �Z A,'C-air handhng unds I <br /> Bathtub Forced air systems <br /> � Lavatory(wash basin) _L Gas piping <br /> �� Shower _L Water heater <br /> �� � Kitchen sink 8,disposal Gas freplace <br /> I � Dishwasher Gas range <br /> ! Clothes washer Clothes dryer <br /> � Laundry tray Range hood <br /> �L Smk(service/barlmop/elc.) = Exhaust fan <br /> I 2 BackOow preventer � <br /> Unnal Heat pump <br /> � — 1_ Und heater <br /> � Dnnking Fountain Bo�ler <br /> � = Floor drain � Refngeratwn <br /> ' _ Grease irap Woodstove <br /> Roofdrains � pther HE4rREC���UPI�T <br /> 1 other L-y6Wh5�� <br /> � — — <br /> ICIN OF EVERETT LOCAI SALES TAX CODE IS�705 <br /> I hereby centify that I have read and exammed this applicalion and know the same to be Irue and correct All prows�ons of laws and <br /> ord�naces goveming this type of work w�ll be comphetl wdh whether specified nerem or not. The grant�ng of a pertnd does not presume <br /> to give authonty to vlolate or cancel the provislon of any other state or local law regulating construct�on or the performance of <br /> construclion That I am authonzed by the owrier of this property�o periorm Ihe work for which appl�cation �s made and I comply vnth the <br /> Stat onlract s L w 18 27 RCW and 296200 WAC <br /> � '� ������ '���� <br /> , ,,,. �r)'I <br /> S�ture ot Owner;GontractodAuthonzetl ngent Date. <br /> I �� <br />