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Oct-12-10 07:5BA �- P.O1 <br />-- - . _ . � . .. ... . . .. - - � -- � ------- <br />PERMIT APPLICATION <br />CITY OF EVERETT IPERMI7 SERVIC�S <br />3200 CEDAR S �REET, EVERETT, WA 98201 <br />425•257-8810 �- FAX A25-25'�-8657 — www.everettwa.org <br />APPLICATIONS ARE ACCE:?TE� FROM 9 AM TO 4 PM <br />SITE AD�RESS <br />5L22 ��/ M«/<�/�ro <br />LE!'AI. LOT NU. BLOCK <br />DE5G <br />---._._ ... --- <br />� _ _ . . 1_._ - <br />ONINER <br />7ARCEL TAX I.b. # <br />TRACT OR 5'J9UIVISION M <br />PERMIT S <br />_....�%/�_._ _�L3 <br />ITY21P PHONE D <br />L�i rr f f�i,�-fviq•l 3zZ z C!�/Llri/�f� ���v ��I/� �. q `,y15 -355� �%'// <br />T[NANT NAML I CONTACY FOii PERMIT �^ ��P�E � <br />Z`ONYHACTOR ... .. _. ...._ .. ..... ; <br />Ey /���.- S�r/, �'- ��,.� � � <br />CONTR. LICEN5E k . <br />USE OF BUILDING <br />l/ <br />�i �' S <br />WORK DESCRIP710N <br />N0. <br />� <br />I E-MAIL _. . . ...-'-- <br />��—�A�GDR�'�S` CITYfZIP ?NOIJE <br />�F'o/ ��� 7r.��-c_ yz s-zs-9-���/ <br />---- �v'� 1('�'L� � __........ .... .. <br />I^ HEl�T SOURCE CONTRACT PRICE OF WORK <br />L Electri� Cas .. , Olher _'J ��J�Uv �! <br />�• <br />N�'> ��Ct /t�� %s' C�� <br />TYPE OF FIXTURE OR ITFM <br />1'u'dcl <br />ti�lhtub <br />I.avatnry (�vash basln) <br />Shmvnr <br />KitChr.n 5ink Y. AI .�i .nl <br />Dishw25her <br />Clulhes �v:fsher <br />Walcn c�aler <br />:ilnk (5crvir,clbar/n10p/utc. ) <br />Backfluw prevenlr,r <br />Unnal <br />Diinkiny FouMain <br />Floor drum <br />Greaso'•ap <br />R00� A�alns <br />Uther_._..... . .__ ._.._ <br />T � � � � MECHANICAL <br />NO. � TYPE OF FIXTURE OR ITFt4 <br />A/C - �ir h�ndliny units <br />Forced :�ir syslems <br />G:�s plping <br />W ate� heater <br />Gus (ireplacr. <br />Gas ran�e <br />Clolhes dryer <br />Range huod <br />Exh�ustian <br />Heat pump <br />Unit healer <br />Boiior <br />Refiperation <br />Woodsbve <br />Other_._........_.... . ,.. _ <br />CITY OF EVERETT LOCAL SALES TAX COPE IS 3105 <br />I hereLy cerility Wal I have read anJ exsnlineJ lhis appllCeliun and know Ihe s�me lo be lrve und correct. nll provisions ot lawu and <br />ordin;ices yuverniny tliis lype ul wu�k will �e cumplied wilh whether speci�ied herein or nul The grantiny ul a permil dues iwl piesunro <br />to p�vr• �ulhanry la viulalr, ur r,unr.ul thu provision uf any other sWle ur local I�w reyulaliny cu��slrucliun ur llie perfonn�nce uf <br />cuns0uction. Thal I 2m �uthnri�pA by Ihr. pwnor pf thix proporty to pr.Aorm Ihe �vork lor which :fpplicalion is made and I wmply wilh Uie <br />Stnto Contrnctors Lo�v 1H.27 FiC1N mtd 291i.'LUU Wi1C. <br />:"-���� . -...--- /C% ^/Z � /� <br />Sipr,atiue ot CwnerlC:ontractq�'IAuthnrizeA rlpent Qate <br />