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' P�RMIT APPLICATIC _ l <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 / I 7J J;;.j� <br /> 425-257-8810—FAX 425-257-8857—www.everettwe.org U <br /> �/�'� � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 1 PM / <br /> SITEADDRESS,r—,� �II�I_UC� f}�,J�_1 PARCELTAXI.D.11 PERMITA � ' ^ <br /> �d�l �'� fw� r l U <br /> v� � <br /> LEGA LOTNO.�A BLOCK TRACT <br /> DESC. � <br /> OWNER � !/�DCRE35 CITY2IP PMONE � .�M/� <br /> R�s� �.vE�ioz (��r�r 9��' <br /> TENANT NAME CONTACT FOR PERM�T PHONE <br /> I �lP�""�eLa l/ heJ �LZS-7s�{ - P <br /> CONTttACTOR �mQy�,Q ODRE35 ciTMmP y�N�� ��70 <br /> CONTFt.l10EN�e�Dl�L�� 9�� S��iU�IDZ� �°��{/!/1�d' Lf/A— <br /> « <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric �es_Other <br /> WORK D SCF RIPTION � <br /> �[.. _ .'_ 2�5 <br /> �[z6��c,e� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXiURE OR REM <br /> ,� Toilet A/C—air handlin�unils <br /> � Bathtub Forced air syslems <br /> Lavatory(wesh besin) Gas piping <br /> � Shower � Water heater <br /> � Kitchen sink 8 disposel L Gas fireplece <br /> � Dishwasher / Gas range <br /> Clothes washer ,1 Clothes dryer <br /> _ n, Y Range hood <br /> 5 nk(servi cel6ar/mop/etc.) � Exhausi fan <br /> Beckflowprevenler _ Heetpump <br /> V Unnel Unit heater <br /> _ Drinking Fountain ._ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Other — <br /> CITY OF EVERETT LOCAL BALES TAX CO�E IS 710b <br /> I hereby ceritlty thet I have read and examined lhis applicetian end know the same to be true end correcl. All provisions oi laws end <br /> oidinaces governing this type of work will be complied with whether specified herein or not.The grenting of e pertnft does not presume <br /> to give eulhority ta violale or cancel the provision o1 any other stete or local law raguleting construction or the perfortnence ot <br /> consW ctian.That I am authorized by the owner ot this property to perform ihe work tor which epplicetion Is made end I comWY v�h 1M <br /> State ConUadors Law 78.27 RCW and 296.200 WAC. <br /> /); � -..-�L�t �� � �� 1'� � -1- <br /> Signature wner/Contrador/Authorized Agent 1e � I� <br /> ,% <br /> � <br /> � � <br /> ' i <br />