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---_t55 r - � ��� I b �c���,�,� I J I� <br /> PERMI� �4PPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CED.4R STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADD ESS �t//j PARCEL TAX I.D.# � �RM�# <br /> D �� iy��, �'' C�% `� , _. 1 C,� n� " � <br /> LEGA LOT NO. BLOCK TRACT OR SUBOIVISION X <br /> DESC. ._ P� � / � �?C� (� Ir ' '� <br /> OWNER y C` `��,x �3p!_ ADDRE59 �ry5v ► '�m I � PHONE�� �, <br /> t,�,A , ���t� <br /> �Y��'lc��iQ�iVf � �rlU� `��1�'Y1�11�5 '�r'l� �I�,�-I ��13�- <br /> TENMIT HAME CONTACT FOR PERMR PHONE`v7(�;,G L{�j(-� S I � I <br /> I\ ���.nC�'�L'�{inCL�� E•MAIL MI�� � I 11��J�'I'1 2�J <br /> Ct��� "l.:ll-EY�1 ��TT �'�-e <br /> t � CvnS�ruC-hi�,wl, lnv <br /> CONTP.LICENSE# <br /> ����,�,��.���-�aN�- �c �,-x. i3c�1- 1'Y1C�r�i��,, ,��-- ��a �i�aZ� <br /> USE BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �f� \� _Electricx Gas_Other <br /> WORK DESCRIPTION <br /> , ,.� <br /> � �J ' 1� ��- jv1�J <br /> �-�.` �y.`uYl�^L�-�'lf�-1 _I — �j��--� <br /> ��C �' C, '"c� �=�— -(� �_ - L L, ` <br /> PL MBING MECHANIC L <br /> N0. TYPE OF FlXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> c�� Lavatory(wash basin) � Gas piping <br /> Shower � Water heater <br /> ' Kitchen sink&disposal � Gas fireplace <br /> T Dishwasher Gas range <br /> � Clolhes washer I Clothes dryer <br /> � Water healer �_ Range hood <br /> Sink(service/6ar/mop/etc.) Exhaust fan <br /> _ Dackflow preventer Heat pump <br /> Urinal Uni�heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Re(rgeration <br /> Grease Irap Woodstove <br /> Roo1 drains Other <br /> Other <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify ihat I have read and examined this application and know the same to br.true and correct. All provisions of laws and <br /> ordinaces governing�his type o�work will be complied with whether specified herein or not.The granting of a permit does net presume <br /> to give authority to violate or cancel ihe provision of any other state or local law regula�ing construction or the performance of <br /> construction.That I am authorized by the owner of this propeRy to perform[he work(or which application is made and�comply with the <br /> State Conhactors Law 7 8.27 FiCW and 296200 WAC. <br /> SignaWre ot Owner/Contractor/Authorized Agent Dale I <br /> � � <br /> I I <br />