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PERMIT APPLICATION <br /> CITY OF EVERETT F�ERMIT SERVlCES ��sU 7-p'<i' <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425257-8810-FAX42S257-8857-vwvw.everettwa.org � _ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 1 PiN -DEBfT 6 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRE33 uM{�� PARCEL iAX I.D.M �'ERMIT <br /> ��0 • +� c.� Z � <br /> LEGAL LOTNO. BLOCN 7RACT <br /> DESC. <br /> OWNER ADDHE9� �e„s��TV_/ZJl' ,e�ONE <br /> II �`311o.�.Lkt l..jt.a1���1 y�� 3 <br /> �- a �, ►+�vn�.N��n!' . �ZDC _ Q�Z70 <br /> TENAN AME CONTACT FOR PERMII PNONE <br /> � l�P�i✓�5 ta'l�'cla� <br /> � I �r�n �,���� y2,S33y•os7 <br /> CONTR[..:TOR���� i1S d..,e_Ve ADDRE88 CITYTP PHONE <br /> /•7 rI�7�+ <br /> CONTA.LICENBE��^�AC��O�(� <br /> V <br /> USE OF BUILDIN6 HEAT SOURCE CONTRACT PRICE OF WORK <br /> 5F� _EiecMc �Ges_Other <br /> WORK DESCRIVTIC�N ' � <br /> ,�c=��c�l, sl-� � 5� <br /> �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%NRE OR ITEM NO. TYPE OF fl%TURE OR I?EM <br /> Toilet /�/ A/C—air hendling unYts <br /> Balhlub y �� Foroed air systems <br /> ory(wesh basin) //ii spiping ii�l <br /> � Showa / �(_ ter heater <br /> �_ Kitch sink 8 disposal � s Rreplece / <br /> �_ Dis asher � esrange <br /> CI es washer Clothes dryer <br /> � Le ndry Irey Range hood <br /> Si (service/bedmop/etc.) � Mhaustfen /;/i <br /> Bac Ilow preventer _ H t pump <br /> Urina _ Unl eater <br /> Dnnki Fnuntain Boil <br /> Floorc �+in Refi nralion <br /> Grease�rep W�'%�Q�e <br /> Roof drams Othrr <br /> Other_ <br /> CITY OF EYERETf LOCAl8ALE8 7AX CODE IS J106 <br /> I hereby ceiitily Ibat 1 heve read and exemined this epplication end know ihe seme to be true nnd correct. All provieiona o1 lews ead <br /> ordinaces goveming this type of work will be complind with wf�elher speciBed herein or not.The granting ol a pertnh daee nef presume <br /> lo givc aulhoriry lo videte or canoH the prohslon of eny othe�stete or locel law regulaling conshuqion or tM pedormence ot <br /> constn:ction That 1 em av0innzed by tha ownar o1 this propeAy lo perform Ihe work fa which eppllcatlon le mede and I comply wHh the <br /> S`teQle Conlr or w .77 W ena 28820�J WA�. <br /> 51§nBlure n onlr��ul�ge� � 1 C� / <br /> E i�l -� 4 <br />