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� � <br /> _� <br /> PERMIT' APPLICATION <br /> CITY C)F EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-BR57—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM / 1 _� Z —�� <br /> / <br /> SITE A DRE � pqRCEI TAX I.D.# PERMI'i Z <br /> � � °�E b�-� I �1 f 3 (I-o _ <br /> LEGA LOT NO. BLOCK TRACT OR SUBOIVISIOu f� . <br /> DESC <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �I �����. ����, � �� � � �:-� t� - ��� . -a� �a3 <br /> ANTNAME � CONTACT FOR PERMIi PHONB ,- D� �a Y� `��� <br /> I�.U�A � L (1� �C�}'LI'�„(1 E-MAII...%�u In,l Q�L:�� A'�A'10�5`1 <br /> GONTftAG O �:L� y�D�-� ^p ADDR[S S � � GITYIZIP VH(1NE ���'� . <br /> ' _� y�6C1 <br /> CONTR. LICEN$E d F� ��k���' ��� �`�F � C �'.c <br /> 1E,�� E <br /> _ F3<��.n,v-.1�o.��-1 '� <br /> USE OF BUILDWG HEAT SOURCE CONTRACT pRICE OF WORK <br /> � 2 Eiectric _Gas,_pthcr � a �O <br /> WORK D C I TION ' <br /> 1 �� ��� �j C.�I-� S S �- �v � <br /> PLUMBING M�CHANICAL <br /> NO• 7YPfi OF FI%TURE OH ITEM NO. 7YPC OF FIxTURE OR ITEM <br /> _ Tnilr,i ` ,1JC— air handling units <br /> Bathtub Forcetl air sy;tems <br /> � Lavatory(wash basin) _ Gas piping <br /> _ Snowor Waten c�alr.r <br /> _ Kitchen sink C tl¢posal fas fireplace <br /> Dishwasher _ Gasr�nge <br /> _ Clolhes wa,her Clothes Aryer <br /> _ Water heater l Range hootl <br /> __ S�nk(servir.crbadmop/etc) Exhau,t fan <br /> ___ Racklio�n preventer = Haat pump <br /> ___ Unn71 Unit heater <br /> __ Drinkn,g Fountain Bodar <br /> __ Floor drain � Refngcr�t;on <br /> � Gmas�(rdp � Wood3tove <br /> RODf dl:JinS O1ttCr <br /> � O�h«r_ –�--�.�—�_., <br /> CITY OP EVERETT LOCAL SqLE3 TAX CODE IS �105 �— <br /> I hereby certity that I have rmad and examined this 2pplicafinn dnd know the,ame lo be Irue and correct. Ail provisions u!laws and <br /> ortllnances goveming this lype pf work wlll be complietl wdh whelher spr.clfied heroin or not. The granfing of a permit does not presume <br /> to give aulhonty to violate or cancel Iho provislon el any othur ste�te or local law requlating conslructlon or thn perfnrmante of <br /> conslructlon. ihat i am aulhnnzad by Ihr� �wner o(this property to peAorm the work fo�which appiic�tlon is made anJ I cnmply w;lh U�e <br /> S(a�e�:ontradnrs Law 1P.27 (�W and 2 '.�WAC. 1 ` <br /> i �/ ' ��� � � � 1 , 1 \ <br /> � �ture O�wnedCpn�rectc r/Au honzetl AgCnI --L� ��1 �_ <br /> o:,i� <br />