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� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET. EVERETT. WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM L �l�1� — 7� <br /> SITE ADDRESS PARCEL TA% I.D.# PE IT# <br /> 0 �c- -v , �� �� �t t3 C�c'�,91c���C�C`C33C � l` -% � <br /> LEGAL LOT NO. BLOCI( TRRCT <br /> i)�SC <br /> OWNER AUDRE55 CITV2IP PHONE <br /> �-�-I-vc�lol ��ie�et� �� �-1r ! �� L y`10�1 Shelb•� C'-I- /�naco��oc �1r5Z21 <br /> IENANT NAM17E CONTACT FOR PERMIT �— rnvnc <br /> ,2�,�.�� ��;zc�.;,.� ��b�_, �,Gl3�I �- S A �/�E� L z�U- ZS�o_ z i�3 <br /> �a.- C�.,�l�l� Dn���.r, <br /> � CONTRACTOR L'�L�/1�Y1 I G ��S 1�G1�' r�L+ND����N/ti� �A�Vuti���I+Z� PHONE�� `)`I�'`/1 C �( <br /> � CONTR.LIC[NS[tt � �/�� ' I il � � �1� �11 � �/ 1 x.l� � I .^I �7-CJ � I <br /> ri v T v� � <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �O-�-c � �r I p S _Electnc _Gas_Gther — (JU[J - <br /> � \NORK DESCRIPTION <br /> j N5 i i� i< <� � i/�G�:lti'� '� F'��k��.,i� � ��n� r� �5�%c�t� l�'-� 0�t <br /> L-/a i2 �✓� i J 1�.; j I L r�-'-� ?`�� k I�,%.L�11 �l3� �� 7` <br /> PLUMBING MECHANICAL <br /> ' ryp, TYPE OP FIXTURE OR ITE�d NO. TVPf OF FIXTURE OR�TEG1 <br /> Toilet _ i+lC-air handhna ��nds <br /> � Oathtub __ Forr.ed mr systems <br /> � ---- Lavalory I�•+�sh�asml _ Gas pipmg <br /> Shov�er _ 1^later hzater <br /> Kdchen sink&disposal _ Gas hreplace <br /> Disheiasher _ Gas range <br /> Clolhes washer Clothes dryur <br /> Laundry tray ^ Range hood <br /> S�nk 15ervicclbatlmopfe!c i _ Eahaust fan <br /> �ackflori Pre��enter Hi a!pump <br /> Unnal _ Unit heater <br /> -- Drinkinp Founlam � -- �a�er <br /> �--- Floordraln __ Refriger.i;�o❑ <br /> Grea,e trap __ Woodsteve <br /> Root drains _ Other_.__ _ <br /> ---- Othcr _ -- ----- �— <br /> J CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> '. !��•reby cerihfy thot I have read and rxamiried this application and knoei the sarne to be true and correct All prowsions of la�ris and <br /> :.�tl�naces yoveming this type of work will be complied v:ith rih�ther;pecified herein or not The granting ot a permu does not presumi• <br /> r.: grve authonty to violate ar cancel the provision af any otlier state or local iaw requlating conshuchon cr Me perfarmance o( <br /> ,�_nstructwn Th�t-F.�m aulhorizeJ by th wner c!4n� proPerf:10 OetfW+n thC e:o!k!or::hich aC'.'6caUon is made and I comply rnth the <br /> .�'.ate Conlract s Lxv 1 < RCV'J 7n JG ::OJ Y��;i' <br /> i <br /> �� �` i ti��� � �� 7 <br /> - � <br /> -_>.�nature n1 O�� dControctor/AuU ontcd�genl Uate 1/ <br /> 2 <br />