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Oct-03- 11 07 :44A P . O1 <br /> ' ..—.—. __ . _.. —. _-7 — . —.._. --. ,— — <br /> PERMIT AF�PLICATION 1 <br /> , <br /> CITY OF EVERETT' PERMIT SERVICES i <br /> I3200 CEDAR STREET, EVERETT, WA 98201 <br /> I 425-257-8810- FAX 425-257-8857- www.everettwa.org � <br /> ' APPLICATIpNS ARE ACCEPTED FROM 8 AM T04 PM <br /> I SITE ADDRE� �y! ^� PARCEL TAX I.D.ti PERtdiT# <br /> ' 2 3��, �, , .5'r <br /> _ � � -��� <br /> � LLiJi�L LOTRU BLOCK TRACiOkSuBDIVISION# � � <br /> � JL:i.., —�—_ <br /> ' OWt�� �— �"� --• ADDRESS CITYIZIP PNONE � ��— <br /> / �J pn ��/)/ <br /> I h �t� r%_` //!1 L./djL-,! � _ 7 � J 7��1 ✓� � OiI..% G'� —�=9 � '- � �c <br /> ' — z- ;� 3 FF ��. �,:5 - <_.5 ����' <br /> TENAIJT NAME I CONTACT FOR PERMIT PHONE <br /> i <br /> � COrv7RACTOR �� —' — �.5� EddAIL _ _ I <br /> 7 CITYPLIP ' Pf1�3NE �� <br /> I ��/��,�/r� �o �,; �r5%c 36'oi ��--� ���. y1��. �s�- �i6'� <br /> ; CON7R. ICENSEJJ <br /> — —.E'� L..-f�'.iSL'�/L-l�Z �rfav� �J��'G'j <br /> USE OF BUILDING HEAT SOURCE CONTRqC7 PRICE OF WORK I <br /> ��P� ,�Elactric _Gas_Olhor r 1 5 �'�� <br /> i WORK DESCRIPTION --- � <br /> i C. Cr�t L �'C�Lil�"J� � C / i " ��`r�'/ /"L. �Il�'i7P4��� <br /> I <br /> � PLUM8ING PdECHANICAL <br /> NO TYPE OF Fl%TURE OR ITLM NO. TYpE OF FIXTURE OR ITEM <br /> 1 - '- I niLii— -'—. —" _--- --' — I <br /> � — A/C-air handling unils � <br /> ._ N;�tMUb � Forced •dir Syslems <br /> -- Luvalory(�vash basin) Gas i <br /> P P��9 <br /> �I __ Slw�.��cr _ W�terhe3fer � <br /> _ Kitc.hcn s,ink S di�pot;al Gas(ifopl0ce <br /> I _ D�sh�va,hur Gas range <br /> I _ C��tnes washer Cbthes dryer <br /> _ 'vv:dc•he�mr —' Ranpe hood <br /> . SiilY,�ServiCE!badnlUU/elC.) Exh3u5t f3n <br /> ; _ Rackf.ow p�Eventor Heal pump • <br /> _. uri��:il � Unit hoater <br /> �, . I)unkiny fountain . — Boilor <br /> ,_._ Piuur hr�in � Refrigeralian <br /> G���asetra�� ~ WUodstOVe <br /> I _ Runt di�qins �, Other � <br /> , OIhCf •--' --' --- —. <br /> �� _ _ V C!!V OF EVERETT LOCAL SAL[S 7N(COOE IS 5105 I <br /> I I herr.hy�;enlify thal I have read �,nd e,xa�tiined this:�pplicalion antl know the same ro be irue and eorrecL All provisions nf laws and ��� <br /> nrdinacr.s��uvcrniny this iypn or wurk will fre complied wil�whether spocitied hurein or noi.Thu graNiny o(a peniiit tloes not�resumc � �� <br /> , to�i:�e auUivnty io viulatn a canre! thr. provision ol any o�her sta�p ur Iocal law regulating cnnstruction nr Ihe portormanr.e uf , <br /> , r.U���slruclirni.Thot I arn authurizcA I�y lhe owner of this prop0rty lo p��rform th0 work lur which applic2tion is inade and I comply with the <br /> �, St,�tU �untnGurs L�w 1tl 2i RC�V and `L90.200 WAC. <br /> � i <br /> I l` /✓. <br /> �.�� ���%' io- �-- i� <br /> -;�;in:�tur�u(U�ti-pe�:CnntractorlFulhoriz 7�A;aunl— Date ( <br /> � . —. -- �-- �-- �—' — — � . <br />