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! <br />PEhiM1T APPLICATION <br />CITY OF EV�RETT PERMRT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />SITE ADDRF SS <br />i, -',/ ' <br />LEf 4l� LOT NO. <br />r�s��. j <br />� I /1 1 <br />Nu �r1•�rJ� �a�l <br />7tNA1: � NAME <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL 7�A7( I.D. # PERMIT M <br />' I� .� ao-7Go'1�9z _� �' �li�/•� <br />BLOCK TRACT /� / <br />� L ): �.(. i ��� <br />ADDRE55 CIT1iZIP PHONE <br />'�, _�J32S` � r a Sn��noM�.cl� y�PfG 36�-ib�-'/ <br />I CONTACTFOR PERM i PHONE <br />CONTRACTOR �,S+O.'�! � <br />LD�+�uc�e•s L <br />CONTR. LICENSE M <br />�r5-�c:LV $'� k L <br />USE Of BUILDING <br />ADORESS <br />� y2S =330 - y rss <br />CITYIZIP PHONE <br />� v�� ZZ7U SI�JIADMi� W� Y9ZC/(i ��"ObL'B�'� <br />HEAT SOURCC CONTRACT PRICE OF WORK <br />_ FIr.Gric � Gas Othar '� S k <br />WORK DES�RIPTION <br />� i iL c� `Q �U rlti .�� �J �v�0 f <br />----- --------- - _ _ - -- _ <br />PLUMBING <br />N0. I TVPE OF FIXTURE OR ITEM <br />S Toilol <br />2� f3aL�lub <br />� _ Lavalory (wash basin) <br />Shc �war <br />_ (___ Kikhen sinF R disposal <br />_�_ Dishwasher <br />-_�_- Clothes washer <br />_� W�lerhoatcr <br />Sink (serviceNadmopielc.) <br />_ ��ickllow pravnnlei <br />Unnal <br />printiing Fountain <br />�loor drain <br />Grease trap <br />� Rool d!ains <br />Other <br />NO. <br />_%-� <br />_.7_ <br />n -, � <br />� �1.., l.i_ . _ <br />MECHANICAL <br />TYPE OF FI%TURE OR ITEM <br />A� : - air handlinc� u:iils <br />Porcr.d air syst�ms <br />G�s pipinc7 <br />Waler haalor <br />Gas lireplace <br />Gas r�nye <br />Clolhes dryor <br />Ran�r, hood <br />Exhausllan <br />Hoat pump <br />Unit hnalar <br />Boil�r <br />Relrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SA�ES TN( CODE IS J105 <br />I hernb}• cerihly lhal I havn road and e*ain,ined Ihis a��plication enA know Ihe: �aine to 6e Uue and corrocl. All prowsions of lews and <br />ordinaces �ovoming Ihis lype ol woik will be complied wilh whelher specili�+d hnrein or noL The e�ranting ol a pervr� does nol presume <br />tu �ivc d�rity lu violatc or canrel Iho ir ��. of eny clhor sl;:to or local law regula�ing conslruetion or the perlormanr.e of <br />conslr i li� . 1 h an � m uwner of Ihis properly to p�Aorm the work lor which apnlicalion is made nnd I comr�y wilh thr. <br />Sla�r� ' n arAai ' I���� C J:tnd "141C+ 200 WAC <br />.l ��Z� •01 <br />Si�n ue ol Gwrer/Cnntrac u �n�Pd Agenl Dal� �(� <br />