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i <br />-- ^ — — <br />: SITF DORESS <br />�. � <br />� LEC��I LOTF10. <br />___l --__— <br />I <br />I�ESC I <br />� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />�200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www e�eretlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />I PARCELTAXI.D.# <br />. �. <br />BLOCK I TRACT OR SUBDIVISION N <br />'� <br />PERMIT N I <br />- -� ��D � ('Xl� <br />� av'nER ..��n��� _...._.. PHONE �' <br />I � . , ,l ' ,;. T ., I n;i' I l��r -' . '_ .' r, � r. 1 � :,�Jr � � {�G i Ic) i <br />I TFNANT NAME CONTACT FOR PERMIT PHONE � <br />� <br />I E•MAIL <br />' C�H7RACTZ)Ti� . AbD�ES�` —�P��—�R�— � <br />�� �. , � ( � l-- ly � ,� iif��,� l�'a 6=i�,1� �, �,��., ,4.)�;I(.7d-'iY�i <br />; CONTR. IICEN5E # � • � �f � ( ��- ��-U I � r �'�, � � ~ <br />i j _ � � �(?/ L� _—___ . <br />USE OF BUILDING HEAT SOURCE I CONTR�`CT PRICE OF WORK <br />I -- E Icclnc G�s __ _ Olhor — I -------- -- <br />� WOFK DESCRIPTION <br />, � , . ,,;.,, <br />yr �- �.t <br />' PLUMBING <br />� NO� TYPE OF FI%TURE OR ITEM <br />Toilol <br />Belhlub <br />Lavalory Iwash basin) <br />Showrr <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes wash�r <br />Waler heater <br />Sink (sarvlcelberlmophalcJ <br />�ack0ow prevenler <br />Urinal <br />Drinking Founlein <br />Floor drain <br />Grease�rap <br />� Ronf dreins <br />Olher <br />MECHANICAL <br />NO. I TYPE OF FI1fTURE OR ITEM <br />A/C - air handling unils <br />Porced air systems <br />Gas piping <br />--- Waler 1•.eater <br />Gas lir�place <br />Gas range <br />Clolhes dryer <br />Ranpe hood <br />EMhausl (an <br />__. Heal pump <br />Unit hea�er <br />Boiler <br />_ Relric�oralion <br />WoodstovA <br />Olher <br />CITY OP EVERETT LOCAL SALES TAX COOE IS 3105 <br />� i hnreby ceritify Ihat I have read anA o+amined �his application ann know lhe same to be Irue and correcl. All provisions of lews and <br />�� � rcdinaces �oveming Ihiti lype ol work will be cvmplied wilh whr�ther specilieJ herein or noL The granling of a permil does not preswne <br />b� yrve aulhuriry lo violam ur canr,el the provisiun ol any olhar state or local law re9ulaling consiruc�ion or �he perlormance ol <br />��-,nslruclion. Thal I am :�uthnrire�l by Ihe owner of Ihis propeAy to poAorm ihe work lor which applicalion is maAe and I comply wilh Ihe <br />'��i,ih: Conlractors Law 1927 RCW and 296 2DU WAC. <br />��t�4. .i' . -,� - � �,'���i�'ii-�`,l <br />?u?-� <br />'�6qnalure of Owne�,CoMraclor/AulhorizAd Agenl Date <br />