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�--- - ------ ------- — _------- --- I <br /> P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERViCES � <br /> 3200 CEDAR STREET, EVERETf. WA 98207 <br /> 425-257-8810- FAX 425-257-8857 -www everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � .,a-t(�-/Q <br /> SITE ADDRE55 PARCEL TAX I.D.M PERMIT M <br /> �)�S I(y�+h Sr `�F :�c• A-L 98`�� �' 'L�!CJ(Z. <br /> LEGAL lOT NO. BLOCN TRACT OR SUBDIVISION N <br /> DESC <br /> OWNER ADDRESS CITV2IP PHONE <br /> �ohnsun �ar���,n LLG �7� ; Ir�l�, ,�t ;� ;7tE. A-z 6,e�t�F wA 9Bto8 <br /> TEIIANT NAME f � G CONTACT FOR PERMI7 PNONE Z�,3�,qyO6 <br /> j l�rec. Nlan�r_�.l�' 1/crt+vrc� �- . N1a# ^�., , <br /> �J" dlpw (_�eGl� ��"- ""� E�MAILAunbCfS��u-�uc�'ln•(A,h <br /> �bATfR�TiCT6�f hTi6RES�— —�ITV1iIR� �Ai5F7€��- <br /> h..t��i'�t� .. �.onENhWI�"v � �. <br /> CON7R LICFNSE M j ' � i/' i i <br /> USE OF BUILDING �HEAT SOURCE CONTRACT PRICE OF WORK— �� <br /> MAn��Fc,��-v�i� Electnc x Gas_Other—_ �� �(�(�n� __ � <br /> WORK pESCRIPTION <br /> � �ca�on �� Ca sP�a`, �� '�S� -�O ���Sh �vrn��/rc <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OF ITEM <br /> 1 otlel AIC -au handliny units <br /> l3alhlub _ Forced au syslems <br /> Lavaloiy�wash basm) _ Gas piping <br /> ihower . Water hexler <br /> h:itchen sink 8 disposal � Gas 6replace <br /> _ Dishwasher _ Gas renye � <br /> Ciothes washer Clothes drye� i <br /> Watei hea�er _ Range hood � <br /> _ Smk �service/badmoplelc.) Pxhaust fan I <br /> __ flack(low pieventer _� Heat pump <br /> Unnal Und heater <br /> Drinking f ounlain Boiler <br /> Hooi Ar�m Retngarahon <br /> = Grease Irap — Woodslove I <br /> Rool Arams Other <br /> Olhei <br /> — — I <br /> — _— — � <br /> _ CITV OF EVERETT LOCAL 9ALE9 TA%CODf 19 J105 i <br /> I hereby ceridy ihat 1 heve read and extunmed thls appGcaUon and know ihe seme to be irue and correcl All provreions ol laws and <br /> ordinances goveinmg Ihis lype of work will be comphed wOh whether speci0ed herem or nol The grnnUng ol a permtl does not presume <br /> Io grve auUiordy lo violate or cancel ihe provision of eny other state m locel lew regulaUng conslruchon or the performence ot <br /> constr�chon Thal I em e�dhonzed by ihe owner ol lhis p�operty to peAorm Ihe work lor which eF�,Gcetwn ia made end 1 comply wilh the <br /> Stale Contraclors l.ew 18 27 RCW and 296 200 WAC <br /> � �i <br /> ISignalure ol OwnedConlractorlAulhonzed Agent Date 1� I <br />