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r ( <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.evereltwa.org <br /> APPLICATIONS ARE ACCEPTEO FROM 6 AM TO 4 PM � � �7`�� <br /> 81TE ADDRESS PARCEL TAX 1.0.• PERMT A <br /> = vo�-a <br /> LE LOT NO. BLOCK iRACT OR fUBDIV1510N R <br /> DFSC. <br /> OYYWER ADDRE CITV <br /> n�ci� S ST�L.AS.R �'ZOI F�A SFS� 14Yt� �L�I�TT <br /> TENIINT NAME CONTACT FOR PERIMT �E 2S3•�IOS•�89 S <br /> I L-OS� I�� 1CAI�1lY- R E�IAAIL <br /> II.C.N�c1� �''�toR S �0 BoK Zs�9 Ks��+U Ls?-VoJ ' �B�S <br /> CONTR.UCENSE� �st�c.K c=ia m� — <br /> USE OF BUIIDING I — MEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas_Other l G�•��n <br /> WORK DESCRIPTION �L���,r�� O� ��S J"�E'rt � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl%TURE OR ITEM NO. TYPE OF Fl%Tl1RE OR ITBA <br /> Toilet A/C-air ha�ling unHs <br /> Bathlub Forced air eystema <br /> _ Levatory(wash basin) � Gae piping <br /> Shawer Waler lieater <br /> _ Kitchen sink 8 disposal _ Gae fireplace <br /> Dishwasher Gas range <br /> Clothes washer _ Clothes dryer <br /> Water healer Ranpe hood <br /> Sink(servicelbar/mopletc.) _ Ezheust fen <br /> BackBow preventer _ Heet pump <br /> Urinal Unit heater <br /> __ Drinking Fountain Boiler <br /> f loor drain Refrigeralion <br /> _ Grease irap _ Woodstove <br /> Root drains Other _ <br /> Other — <br /> _ <br /> CITY OF EYERETT LOCAL 5ALE3 TAI(CODE IS 1105 <br /> I hereby certify that I have read end examined this apptication and know the same to be true and cortect. All provisfon�oi laws and <br /> ordinances governing Ihis type oi work wili be complied with whether spec�ed herefn or not. The grantinp of a permH does not presume <br /> to give authority to vidate or cancel the provision oi any other state or lowl law regula[ing conatrudion or ltu peAormence of <br /> construction.That I am authorized by the owner ot ihis property to periorm the wortc for which applicetion is mede�nd I canply wilh tf�e <br /> State Con lors Law 18.27 RCW nd 296200 WAC. <br /> � �> P- �-/7/D <br /> Signature ot ned ontractor/Authorized� Date <br />