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NERMIT APPLICATION
<br />CITY OF EVERETT PERMIT SERVICES
<br />3200 r_EDAR STREET, EVERETT. ���A �8201
<br />425-257-3810 - FAX d25-257-8Ei57 - vnvr� evereltwa ory
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<br />� y' � �� � � � � � � APPII�l�IONS ARE ACCEPTED FROM 8 AM TO 4 PM _ ���.0 � � ��� �
<br />SIT[ ADDRESS PARCEL TAX I D. N i PE tr11Tf� f(
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<br />OV:NCR ChpdtJ�T��KW �DDR[SS CITY2IP PMONE
<br />�-�,1Q�2-CvtluQR.Sr,�l..lt 11�3�-b���A��SC- �oil�elf y7� -'IV3-ll�$
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<br />TF.NANT NAh1E � !'ONTACT FOR PFRId1T PNONE
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<br />i;� iNiftAC10H AD�RFSS t CITI'�ZIP PHONE �
<br />���kulR����e0-p��Sr`�,I-�. 1103�-3s �u�SE �J.(�j� �(�l5'74?�-IllSj
<br />cor�ra i ic[Hse a 9.90 ��
<br />U56 OF f3UILUING j HEAT SOURCE . CONTRACT PR{CE OF WORK
<br />S�f�r�\L ��m��y I�r•f�.�1cr.}I ,p „
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<br />WORK DC.SCRIPTION
<br />(� 6 V� 3-1 v.-�t V- l bv� •� �Ml�.ti �t � 4�*-� � (- �r, µ �:
<br />-1
<br />,;.� `�
<br />PLUMBING
<br />r+�� rrre or �ixTUH� oH ir�a+
<br />� 1����d��l
<br />77� ,n,��,i�,
<br />� . ._,II �ry (N,1511 h;15111�
<br />.i'f
<br />I �� ����n s�nA 8 Ais�,as21
<br />� � � .:asliei
<br />� r���s washer
<br />� .. .�^ hC81Cl
<br />� � ��,rrvicabaNmople�c.)
<br />I � � .H�ny prevenler
<br />i
<br />. ��nyFounta�n
<br />�� i�,�u drain
<br />Grease Irap
<br />Rool drains
<br />)ihef
<br />t3 u-+Ln-c - tt a 3 l�
<br />MECHANICAL
<br />NO � TYPE OF fIXTURE OR ITEht
<br />�!,. C�- au handlutq unds
<br />1 ' ��rp� 2ir s��sten�c
<br />�' �.11 �)I�Ifll)
<br />� ..,I�CI hEilll'f
<br />. ( ,.�s hreVla,_�.
<br />� .;�is ranyc
<br />_ � ' �lolhpsdrjpi
<br />1 R:mge hou�l � In�Qeu
<br />5 !_�haustlnr
<br />I �u�atpwn��
<br />I Un.� hC.fter
<br />f�o�ler
<br />Relri�eration
<br />Woodstove
<br />Other
<br />CITV OF EVERETT LOCAL SALFS TAl( CODE IS ]105
<br />���-���b, cenlily Ihal I have re.id ;ind examined II��.; npp6cation and know Ote samo lo be lrue and correcL All provi5i0n5 ol IBws an�
<br />�. �rdmac.es go�ernin� Ihis type ol work wdl bo comphed Hdh whelhor specihed herein or nol The granbng of a permd does not presunie
<br />. ,,r• au�hinit� h: �.uda��� er vanr.rl ihn pio��i&ion o� any oiher stalo nr local lan� reuulatmy constructinn nr R�e pprti�,rm;�n�:-e rt
<br />� . . �i� •, ti,.,� � ��., , �. . ���,d t�; u,o ownm olthis propert� t.� ; ��r� ,m� tr��. ,; ,� �� . . ��, ,, , ��al � � ,.. � . .. .
<br />� ..., � . . ,.. . ... ,. � , , . .. ...,
<br />� � . � . � ... . � .., .m.l ;'��G 200 N'AC.
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