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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8�10 — FAX 425-257-8857—vn,wd.evereltwa.org <br /> APpLICATIONS ARE ACCEPTED FROM e AM TO 4 PM s _CI��3 <br /> SI7E AUORE-SS PARCEL TAX I.�.# PERMIT# <br /> IU�," cc���ooco3soo rn!�os - �) `I- <br /> LEGAL LOTNO. BLOCK TRACTQRSl1BDIV1510N# <br /> DESC. <br /> OWNER ADDRESS CITYl�!P PHONE <br /> � _G�e_�.�.��s�u' �.�. �o� • �- ' � Og <br /> YENANT NAME cONTACT FOR PERMIT PHONE � �� ���?� "��� <br /> -�WA(�1.� � [� �LSI.IU^..�1 E�r1Ali_](�.1��,1{�iJU[(�5'U'1.��+'1 <br /> C NTRACiOft `���_� `,�hq AODRESS l�� i j I 4f? CI'IYRIP 1 ' PHUNE�'�/�-�i V� , <br /> � � I" L SC'J.y-t�I-L �C�G ��F `i"�L� ('.-C Y <br /> � CONTR. LICENSStI �p n CtC;��;,�� <br /> F3r.0 rv�1\`�D.��-1 `��'1 <br /> USE OF EUIL�ING HEAT SOUj2CE CONTRACT PRICE OF WORK <br /> � � a��-q <br /> F _ _e�cctnc ��Gas�other <br /> WORK DESCRIP710Y �,� �X'� ��.��/� (] a � � �i C-C. '�' �0. °j <br /> �0.� Y�.���' �l "1 <br /> PLUMBING MECHANICAL <br /> NO, }YpE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ` Toilet A!C-air handling units <br /> � Bath�ub � Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> � Shower I Waterheater <br /> _ Kitchen sink&tlisposal Gas flreplace <br /> �ishwashcr — <br /> _ Cl�lhes washer — Gas range <br /> Water heater _ Ctothes dryer <br /> Sink(servicelbarFmop�etc,) —, Rnnge hood <br /> , BackOow preventer � Exhaustfan <br /> � Urinal — Heat pump <br /> ^ Drinking rountain _ Unit heater <br /> Floordrain P,oiler <br /> � Grease trap — Refrir�eration <br /> � Roof tlrains � Woodstove <br /> ^ Other , OthBr�` <br /> CI7Y OF EVERETT LOCqL SALES 7AX COOE IS 7105 <br /> I hereby certdy that I have rentl and examined Lhis applicaiion and know the same;o be'rue and correcL All provisions of laws and <br /> o�dinances governing ihis type of work will be complied with whether specified herein or. oL The granting of a permit does nor presume <br /> to give author.ty to violate or Cancel the provi510n of any cther state or IOcal law regulating canstruction or the performance oF <br /> i r,onstP C6on. That i am authoriz d by the ownar 01 Utis property IO perturnt he wor1;tor which application is matle and I comply with the <br /> State oMracto,Law 1n,2i and 296.� 2�Wqp <br /> i � � vl I^ <br /> � l � '� <br /> , �g alure of wner�Contract r/qu onzed Agent D te <br /> � / <br />