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- <br /> � PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CE�AR 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 �, �a-07 <br /> SITE ADORESS � . � PARCEL TAX I.D./ pERMIT� <br /> _ I Dt��� ��, �,. :� , ��, �j�e��r;3UoA3oc,q �(�-) • �� <br /> � LFGA LOT NG. BLOC TRACT <br /> �7ESC. <br /> OWNER ADURESS CIN21P PNONE <br /> D'aVI�CI_� 7�,d�+ SI�EVIN `fyC��i a3a �i 5t. s.�.� <<In,�,�(v . �A, `S�aO <br /> TENANi N( N[ CONTACT FOR PERMIT —�pHONE <br /> ��'�G, t JU�•I S!1 Y�� ti I�K. (� Hir '��r , �-{��n�C Ltni�rr '1J5� 3S 3- Syl�y <br /> '�NTRACTOR 1 T AODRESS CI�fV/ZIP PMONE <br /> �i ��L- �1���5TYU( �'�l�N I)�V�1°e.LH <br /> CONTR.LICENSEI �L'N,)J N�'y���IS E �'e:t N �'jS j`� j S`I�y <br /> _ H Nc�c�Q � U ,P�t.N— — �i�,.�c`I <br /> USE OF BUILDING HEAT SOURCE C NiRACT PRICE OF WORK <br /> � � v — — f,��� 31,�,u�. <br /> �' S� �t l-E, A_Elactnc Gns Othei "j � ��$, d� ��w p,.!-� <br /> DWORK DESCRIPTION ( �r, r y 1 � (y�� $, al <br /> I�l�a��TlIlv..rn�� [�t� �" 1?Ny�r�:'����-vc� �'+'U�v.E <br /> I <br /> IPLUM8ING MECHANICAL <br /> NO. TVPE OF FIl(TURE Ofl ITEM NO, TVPE Of FIIfTURE OR ITEM <br /> � Toilol aC-a�r hendling units <br /> �_ Bethlub _L Foiced air system; <br /> �,� Lavetery(wash basm) Gax piping <br /> � Shower �_ Walar heater <br /> J_ Kitchen sink d disposel Gas fireplece <br /> �_ Dlshwasher Gas rengo <br /> _ Clothes wenher Clothes dryer <br /> _ laundry Iray = Range hood <br /> _ Slnk(service/bar/mop/elc� �_ Exheust fan <br /> __ Beckllow preventer Heal pump <br /> __ Unnel Untl heater <br /> Drinking Founlam Boiler <br /> floordram � Refngeration <br /> _ Greese trap Woodstove <br /> _ Rool dralna Other <br /> Olhe� — <br /> I -- - -- - <br /> I _ CIiV OF EVERETT LJCAL SALES TA%CODE IS J706 — <br /> I hereby cenhfy thal I have read antl examined Ihis apphcaGon end know Ihe same fo be true and correct. All provisluns ol lews and <br /> ordmaces goveming Ihis type of Noik will be comoGed with whether specified herem or nol The gran6ng ol a permil doee not preaume <br /> 'o grve authanty�a violate or cnncel the provlsion ul any other state or local lew regulating cunstrucuon or the peAurtnance of <br /> conatniclion Thet I am eulhonzed by the owner of thb prcperty to peRortn the work for whlch qpplicahon is madd erd I comply rnth the <br /> Stele Connaclors Law 18 17 RCW and 29f,200 WAC <br /> // . .((� - /_,� / _ C 1 <br /> C <br /> - n ture u1 edCortrer,lor/Aut onznd Agenl — e��— <br /> y <br />