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P�RMIT APPLICATIi�N <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 /> �� 'PPPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> I SITE ADDR� �:�e.r �r O� 39 z 8 ao y a I "1 o�P��`� -(��/ <br /> (J� <br /> L[GALl LOT IJO. BLOCK TRACT OR SUBOIVISION p <br /> DESC. �'1 C�.UCtll � �S �ViSi � /� ( <br /> OWNER ADORE55 CITYIZIP PHONE <br /> Sou,•�IU�eU Conirtcl-w-S P a. 3�x ,�o�r3 Fve�ct+ 9bz�3 �l.ts�8�o� �zv� <br /> TENANiNAME CONTACTFORPERMIT PHONE (�ys. �7a. -7zc� '7 <br /> Iri.�-f'� �eck E•MAIL S���G�f PfC�Pf}i[S1.L uQf J�n <br /> GONTRACTOR ADDRESS CIT IZIP 0 E /� + � <br /> .��nc�V�e� Cont�ci f,,�S �.CJ {,�UX ,�G�13 ���.� r-�- �5'bzr3 �/ZS� �j7u- 7z�/ 7 <br /> CONTR. LICENSE# <br /> �Ucz� c� CL 9•51 K �t <br /> USE OF 6UILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �'�U I +�� ' �Arti.'� � A n �Eleciric _Ga;_Olhcr \� �SU UUU <br /> y I1fAri�n..�."� � <br /> WORK DESCRIP710N r <br /> ,��Pw� T�cvnf�����s - S�PA��S-Gr�7 <br /> `��s+ �c -tvc� uR� � " � �__ I <br /> PLUMBING MECHANICAL ' <br /> NO. TYP[OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> �;_ ioilet __ ' - ir handlinq unils I' <br /> � f�alhtub � Forcec air systems �I <br /> 1 L.rvatory pvash basni� Gas pinc� <br /> Showe� 1Ne� �r heater <br /> Kilchen sin4.R dispu:�;il G� s fireplace <br /> '�a , r,r as range <br /> 6 Clolhes w c.her Clolhes dryer � <br /> �' Walcn c� Ici � _ Ran�e hood <br /> Sin4�.(sc ;icc�'I�udinu{�'utc.) / o [xhausllan <br /> _ Dackflo r prevenler _ <br /> Urinal : Unil healer <br /> Drinkin� Founlain Boiler <br /> fluord �iin Re(rigeralion <br /> Grease trap Woods�ove <br /> Roof drains Othor <br /> Othcr <br /> —� — — <br /> qTY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br /> I hereby ceriti(y that I have read and examined Ihis application and kno�v Uie samc to be lrue and correcl All provisions uf laws and <br /> ordinaces�overninq Ihis lpp��ol�vork wiil be complied�vilh�tihether specitied herc�in or noL The granting of a permit does not presume <br /> lo c�ice�ulhurily lo violale or canrel ihe provision ol:iny olher stnle or local la�•:regulatiny cunstruclion or Ihe perlormance of <br /> construclion.That I am uulherizud bylUe�vner ol lhis piuperly lo jierfurm ihe o�ork for���hich applicaliun is made and I comply wilh lhe � <br /> Slate Cuntrai lore�,nv lil '7� Hy��_' ". OU.LNAC: I <br /> / � '' ,....-... , <br /> %� ���_ ��lL'�'���� <br /> Signature ol O�vnedContractudAulhnnzed Ayenl D•al� l I <br /> lZ <br /> �__ _ - _ _ -- — � <br />