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- - -- - -- - - - - - -- -- - -- - _ _ __ , <br /> ' PERMIT APPLICATION ' <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 j <br /> a25-257-8810- FAX 425-257-8857 - www everettwa org , <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.M P RMIT M : <br /> 15 � n fh r S�- 2����DD � l /,2�CU �I 0 �0�4 ; <br /> I EGAL LOT NO BLOCK TIUCT OR SUBDIV1910N M <br /> � nrsc '� A � ' )N S D�c' 1-�if,�T- � C � �/.%C:'�/2-C�7 <br /> OWNER ADDRESS CITYlLP PNONE r _��^\ <br /> �Ah L E ' > > l ui/J <br /> ��v�lr,esr C�,vs� ��� �dx i3��- M����S�%il� W� -��-�-,� � <br /> , TENANT NAME TCONTACT FOR PEH/M�IIT PMONE ��,�'" .j S',Q _ .�/��T J <br /> �.J�J��S^�L/7 + !����JC��V E�a� G�GII�)1�eC� J� 17"11111{9m <br /> � — ti= <br /> � ����,� _F ���unir,�yC�,vS'ri�l�.��Trc;v �Di��� �s�i9 /�1�4�ys'vrr_1� Su����s'9 -s��� <br /> CONTR.LICENSE M ,,NL7��/_ !. / �L Nf- _____ <br /> � � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK , <br /> NG I1'� .)� /� _Electnc _X_ Gas _-- OtnPr -- — <br /> WORK OESCRIPTION ��Iv 1�,�� — ���� � � � � I <br /> { <br /> i � <br /> � <br /> PLUMBING MECHANICAL — - ' <br /> I N0. TVPE OF FU(NRE OR ITEM NO TYVE OF FI%TURE OR ITEM � <br /> � '� Totle� _ NC -art h0nd�mg unds � <br /> ! 1_ Bathtub / For�au syster•s <br /> � !j Lavatcry(wasn has�n� �, Gas pioing <br /> J ShOwC'r _L W3'Cr hpe1C� � <br /> J_ K�Ichen smk R tl�sposal ,� Gas fireplace ' <br /> _/ D�shwashci Gasrange � <br /> � � Clothes washer � Ciothes d.ryer <br /> I _ 4_ Water heater ___L Range hood <br /> S�nM (sernce/bar�mup�e�.: ) [■haust lan <br /> BacAflow preventer 3� Heat pump <br /> Unnal Und heater <br /> Dnnking Fountam _ Naler <br /> � Floordram .. Reingera6on ' <br /> - - Grease Irap _ Wa�dslove ' <br /> Rootdrains Other- -_. --' -.. . . . , <br /> _ Olher— ... __ _. ..._ <br /> I — -- ---- <br /> — ----_--- <br /> CIIY Oi EVERETT LOCAL SALEB TAl(COOE IS N05 <br /> i I nereby cert�fy that I have read antl eram�ned inis apphrahon anA know the same lo be Irue and co�red All piov�s�ons ol laws and , <br /> Ior�mances govern�ng Ih�s rype of v.o wtll be compiied with whether sper.�f�ed herem or not The gran6ng of a permit Ooes not presume <br /> to g�ve authonty to v�oiale or rancei e prows�on ol any other s�ate o�ioql law regu�a6ng mnstr�cUon or the pe�1vmance ol <br /> � construdwn Tha� i am authonze y the ovmer of th�s property lo perform the work for wh�ch apD���hon is matle and I mmpiy vnth the <br /> Sta Contractors l.aw 1B 27 R antl 296 200 WAC <br /> _ - �, <br /> ' �-�i / �1'il� <br /> '� at ue o enContra oUAuthonze9 em Date � � <br /> �_=..---- ----- — --- — �- ---- - � - --- - ---- - ---- -- -- �--- -I. <br />