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� • <br /> PERMIT APPLICATION <br /> C{TY OF EVERETT PERMIT SERVICES <br /> 3200 CEOAR STREET, EVERETT, WA 38201 <br /> 425-257-8810—FAX 425-257-8857—www.everetiwa.org <br /> APPLICATIONS ARE ACCEPT6D FROM B AM TO 4 PM ,_��---� <br /> SITE ADDRESS , PARCEL TAX I•6•7R P �# <br /> :.� p � 8015�5��1 � <br /> LEGA LOT IIO. �LOCK TRACT OR SUBDMSION» <br /> DFSC. <br /> OWNER ADDRE99 CRYTP PHONE <br /> �'�m C�t P .e ►,.� �a- ao� • 3� • �� � - <br /> 'fE-NANT NAME l � (� , l-� <br /> CONTACTFOR VERMR VHONE aD� ,�a Q� �y�O <br /> .�A t(Y�i� (� C J N'U�.a-rl e�+uia�+YYtJ tc�vY <br /> conlxn �,�sv-�, -3�r'� AD RFss y��i 1 PLc�n�,�l.� � a� a a s a�+o Gc m <br /> c�61�E <br /> CONTR.UCENSE9 �jC�..1��\_ _ "1�1,P ''` <br /> C� Y� '�— CONTRACT PRICE OF WORK <br /> USE OF BUILDING HEAT SOIIRCE <br /> S�n _Electric '��as_Otner , � . <br /> K <br /> - WORK DESCRIPTION a 3 ��+"" � <br /> ��a�.` c� .�e x•� ���r�q q <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FUIlURE OR ITFld NO. T'PG OF FIXTURE OR ITEM <br /> Toilet _ NC–alr handiing un'ds <br /> Bathtub FOrced alrSystem5 <br /> Lavatory(�+�ash basin) � Gas piping <br /> + Shower � Wator h0ater <br /> Kitchen,ink$dispasal Gas fif¢pleec <br /> ^ Dishwashxr � G�5 range <br /> — Clotlieswanher � Gloih03dryer <br /> WaMr h6atet -- RDngn hood <br /> Sink(servioelhadmopletc.) _ Exhaus[fr�n <br /> � Dacktlow proventer _ Heat pump <br /> Unnal _ Unit heat2r <br /> _ Drinking Foundin Boilor <br /> Floor tlram RclrigemUon <br /> Graasetrvp �. Waalsf9Y0 <br /> Roof drains _ Other <br /> � Other — <br /> CITY OF EVERETT LOCAL 3ALES 7AX CODE 13 J106 <br /> I hereby certiy that I heve read and ezamined this applicetion and know the same to bo we and comect All provlsio2s vt laws and <br /> ortllnances goveming this type of aork will bo complied with whothor spoGfied horein or noL Tho graming ot e pertnit does not presume <br /> to give euthorrty to violate oi rancel ttre prwision of a�ry other state or local tow reVulatln�conswc5on or lhe peAonnaner oF <br /> con 'on.Thot I nm eulho ' by the owner of this property to perform the wortt for which application is made end t camply wflh the <br /> le rtdadors law 1@.Z7 and 200 WAC. <br /> ^ �i� / <br /> ature of wnerlContra d u hodzed P.geM Defi <br />