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Nov 25 09 12:12p Lori Reynolds 2nG35a-1259 p.? <br /> 1 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 96201 I <br /> 425-257-8810– FAX 425-257-8857–www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I <br /> SITE ADURESS PARCELTAX I.D.R PERMIT# <br /> . �C 5�- S' c � (:Z� <br /> LEGAL LO7 NO. LOCK 7RACT OR SUBOIUISION R <br /> DESC. <br /> OWNER AO�RESS GiY+ZIP PHONE/,��5-a�G�E-7w�� <br /> C .�c�r��.��r�l�i x�,� i 11 O7_1�_5�1^P St= �^"Jereff c �?OR <br /> 7ENANT NAME CONTACT FOFi PERMIT PMONE—i �q�G 3�S-� <br /> I -�-Ci <br /> I���- � �`l'-� ��.0`�L� E-MAIL <br /> —���7�jb{�--(' �lq -6RE�` "� CITV2I PN`LN Q '�( <br /> C�`CIl�-i..�iL F'«-�k`� Il�ct\l�� ' �4 � �U ',�!'""7 �'�..1niQ.� �l �,� 7 1 �' ', � � (: <br /> � CONTR.LICENSE# c �7 F\ J �y�/ <br /> C_G'�l� )��l 1�/��� �V�P �'�C;--l� f 1 <br /> I USE OF BUIL�ING I HEAT SOUHCE I CON7RACT PRICE OF WOBK <br /> � I Eleclric�Gas__Olher �: ��-��-. <br /> .�.�,� � _ , <br /> WORK UESCHIPiION r�-�� <br /> ����r��C:�'..�� J 8 1 —�"l—i I.J I �� `� � GLL� ��V rt'1C1.�� I <br /> l <br /> PLl1MBING MECHANICAL !i <br /> NO. TYPE OF FI%TUHE OR REII NO. TYPE-OF FU(Tl1RE OR ITEM <br /> � Toilct A/C—eirhandlinpunits <br /> � �athlub � Forced air systems <br /> Wvatory(wash basin) _ Gas pipng <br /> Shonror Water heater <br /> Kitchen sink S di,po;al _ Gas fireplace <br /> DisUwasBor Ga,wnge <br /> Clulhes wa:Jier Cbthes drycr <br /> WaWr haater Ran{�c haod <br /> Sink�scrvice�badmop,'etcJ Exhausl fan <br /> �3�cMlow preventci _ Hoat pump <br /> Uiinal _ Unit hcaler <br /> _� Drinhing Pountaln � Boiler <br /> � Flooitlrain Retriyeralion <br /> � � Grcase irap _ Wo�tove <br /> Rool drains Othcr . _ <br /> -- Olhcf __ --.——_- <br /> _ - -- — —. �------ � <br /> CITY OF EVEREIT LOCAL SA'_FS TAX f.OpE IS 3105 <br /> I hcwby cori�ify lhat 1 have read anJ e�mined;h1s appl�cation ond know the same ta be lrue and correct. All provisions ot Wws and <br /> ordu�,�ces c�overning ihis type of work wiil be complied wiih�Wiotlier specifed herein or noL Tiw granting cl:�pemiit doos not piasumo <br /> �o{yivo aulhwiry lo viol�lo or eaneel lho provis�on oi any ather s,alo or local law re�ulalinc�consL^�etion o�:he pedormance ol <br /> � wnstru,:tio�.Thal I�m aut6orized by the owner of Ihis properly to pederm�he woik tor which appticaUon is mada and I wmply with Ihc <br /> �� State CJNfactorc W 8.27 RCW nnd.. . 0 WAC. <br /> � ��f . � ��' 11 ��l�i <br /> SignaWro ol wnerrContr`C or jlulliacatl Agent U io <br /> ._� I <br />