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� � <br /> PECi,. IT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C6DAR STREET, EVERETT, WA 98201 <br /> 425•257-8E310—FAX 425-257-8857—www.everettwa.org <br /> _ APPUCATIONS ARE ACCEP7ED F;20M 8 AM TO 4 PM (� ����—�3 <br /> S�TE�DDRESS PARCEL T X I.D,f� PERMIT fJ <br /> ��. � CG v-, 1��-0.53 <br /> IEGA LOT NO. O�OCIS TRAC7 OR SUBDIVISION N <br /> DESC <br /> `OWNElR ADDRE35 CIIY/Pp PNpNE <br /> ��-1 U r r��c�/ �� �- o�Ck � �n 83 � 33 <br /> TENAN7NAME CONTACTFORPERMIT PHONE ,.�D� �ae, aSl1OO <br /> I�flti i <� Cy Ui1.f��..r1 �;, bCu�Utio.�l <br /> co ioie ���� � �n� noo ss 4�o:i � �7 CI Y�t�P E•MAII P IYI.�e�i, _�. . <br /> CONTR.LICENSE d r L ��`��� �� d a�C ��q � ��'�'�� <br /> F3'r�.�.,Y,1�a�1 �� q���,6 <br /> USE OF BUILDING HEAT SOURCE I CONTNqCi PRICE OF WORK <br /> S�� ,Elecv�c �Gas_Olner r�� <br /> WO DES RIPTION <br /> ���a c-e, e.,x�S-� r� �, a � t� F�f .� -� c�ct � <br /> 12.0� U�c�.�-+� ��.�c.r <br /> PLUMBING MECF�ANICAL <br /> NO. IYPE OF FIXTUR[OR ITEM NO. <br /> .. , TYPE OF FIk7URE OR ITEM <br /> _ Bailhwb NC—alr handlinp un�ts �� <br /> _ Lavatory(wash basin) �� F�'cetl air syatAm; <br /> _ Shawor Ga�pip�ng - <br /> _ Kdchen sink 8 tlisposal �-- V`'��^< <�camr <br /> Dishwashe, _ Gasfircplace <br /> � Cinthe&washcr ____ Gas rang+ <br /> _ Watcr healer __ �i�thes dry�r <br /> ` Sink(senncrlbar/mop/etc) _ Range hood <br /> _ Backllowp�eventer .._ Eshaustfan <br /> � Unnal I�eat pump <br /> _ Dr�nking fountom � Un�Uicate� <br /> . F�ootdram �oiler <br /> . Grease trap .. -_ �rl�i9eratwn <br /> Rooldrains _ _ Woodstove <br /> . Othcr _ Other__ <br /> — — __��__ <br /> _� __. _— Clry OF LVERCTT LOCAL SAIES lAX COI7E IS J705�_�� --- — <br /> i I,r,reby cert�fy thpl I have read and exnninn��his appi�calion anA kno�v lhe 52me 10 bC IAi�2ttd gpry9C1. All prOvi6ion5 0f IBwS 00tl <br /> orJmanr.ey g�veinmg this rype o1 work wi0 bc cnmphed with whether spr.ti�ed hp�em a nnt The granting of, penrut does not prosumr. <br /> to gr�e 0ulhnnry to v�olale o�wncel the provisron of any othr.r state or local la�v mgul�Gnp consfracuon c�u,w p�rt�rmon�,+oi <br /> �con�1 ction 7na�!am auuionz�d ny pn owner ui thic prpperty to perform U���yo�k tor wpich applicaUon�y made onA i compiy witn thc <br /> fetc .onlractors low 10 "J.7 .7nd�6 200 WAC. <br /> �- /�_[� � c� a� 3 <br /> 85' ature"o�7Jwnr.nGomrnct u u honzed nqant ate <br /> I_( <br />