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Sap-13-10 07:59A P.01 <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.uvoreltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITEADDRESS <br />/ PARGEL TAX 11). N PERMIT N � K <br />LECALI LOT NO. l ULOCK TRACT OR SUBDIVISION p <br />OLSC.r L. — _ <br />OWNE11 AODRESS. ___. �./��� CITYflIP PHONE <br />71 <br />1LNANT NAME CONTACT FOR PERMIT PHONE <br />_ E-MAIL <br />CONTRAC OR �-/�T:DkE55 �•,�r---""----'—�IYP/21P---'PIiOrF-€'--`�-'---- <br />'4""dPn .Jl�j�i fC�I"f��•'.� .�1i���fjY'r'K jg!/-i� /`Z7'��/�Z�`� <br />I CONTR. LICENSE # '7 <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />1, r or <br />...L G Clectric —Gas _Other <br />WORK DESCRIPTION'- <br />n .._.. _..__-•-'---_----. <br />PLUMBING <br />NO. I IYPL OF FIXIURL OR I10,1 <br />NathlLib <br />__ ... Lavatory (wash basin) <br />Shower <br />Kilo,on oink A dispus"I <br />Uishwashdr <br />Clulhe:: wat,hur <br />--_ Writes healer, <br />_ Sink (si�lvira/bnr/nlophttr,.) <br />_ Ilarktlow proventor <br />_ Urinal <br />_ Drinking romValn <br />_ Floor draln <br />__ Grr�ase [rap <br />Pool cloms <br />Other <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />f NC air handling unit: <br />Forced au systems <br />Gas pipinq <br />Wulur hauler <br />Gds fireplace <br />Gas range <br />_ Clothes dryer <br />_ Ranoe hood <br />Exhaust fun <br />Heat pump <br />_ Unit healer <br />Buier <br />Refrigeration <br />Woodstnvn <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hrcby nrritity that I have rrarf and raan:ined tilts applicalien cold know Iho same to be truo and rmnror..t. All piuviSiunS of laws mld <br />ordinocus yuverninp Ihie; ly'hit of work Will hr.- r.0,111A d with µ((ether specified herein or not. The granting at n permit does not piesunle <br />In grvd uulhunly to %iulalr. or ranr.ol Inn provisinn at any other slant rn Inca( law reyuk+tinU cunslruclion or tho prrformnner. at <br />rnnstruMinn. That I nn1 autltnrirc,l by the owner of this pnipenl• to peifuim the work fur which application is made and I comply with the <br />Statn Contrilq1i ,lw 1 RC'N and i '.21}FI WAC. <br />... 3-. <br />5. naWiN ni Llwner/Gunlrai'lur%liuthori: rd Ag�int ate (e <br />