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- - - -- - - -F .RMIT ��PPLICATI� N l <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FA'< 425-257-8857 —Nnvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM T04 PM 'J��-�$ —/(� <br /> SITE ADDRESS PARCEL TAX I.D.p PERMIT M <br /> ��`�LI \1�'~ \� S�:_ C�J� �I•�S " — <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ICE'kl4 �3TY�,EE�'�S��iaw �°IZ� 110�" S: lE �JE(Lf'R �D. _ <br /> TENANT NAME CONTACT FOR PERMIT PHONE r���7 C�� /�-5� <br /> � <br /> Z.`6HTIFA�T6� D•�•� �1tifLlL-- E-MAIL . - <br /> Ess � <br /> �c)���< 1 <br /> CONTR. LICENSE1t 1 �N ��,�-� Qc(L �...fTIF.P` ����re� D7V1- I�3`� <br /> USE OF BUILDING HEAT SOURCE CON7RACT PRICE OF WORH <br /> iC Eledric _Gas_Other � �� , � �,�-, <br /> WORK DESCRIPTION RE•n•�+c P:�`t y:�Ll�c:� ��a.�� Cv-ct,.-•�� St,���.a�.� � �.�r�•�• � c.6.�,.a� C'�v,�"i <br /> �e-�i�.�f, ♦�:.�.� . E�-Y.'ue+� � 1Y:.�tw��- V�.�+1•ava� � 4slwt+�. .�- �E�H.+1` C.Ny�a:.ti � �I.AIH�E <br /> N'r_�> C,w,� .a� `>�:.�.•��•.1 �'� �3_�V.l.c.�� Q�.:^nP.r���rU:.��a-��.Ol . �Ntiti•..H. NC..1 f!M•.+: <br /> � �""'��p"'��' �`—�ls`"''�'�` MECHANICAL <br /> PLUMBING <br /> NO. TVPF OF FIX i URE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Todel _ A/C-air handling unils i <br /> �atMub _ Forced nlr systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower �__ Water heate� <br /> Kitchen sink&Aisposal __ Gas fireplace <br /> Dishwashei , _ Gasrange <br /> Clolhes washer _ Clothes dryer <br /> tj� Water heater _ Ranc�e hood <br /> � (.�_ Sink (serviceibadmopletc.) _ Ezhaus�fan <br /> �� � Ba:ktlow p�eventer Hea�pump <br /> Urinal X Unil heater <br /> Drinking Fountain _ E3oiier <br /> Floor draia __ Refrigeration <br /> Grease Vap _ Woodstove <br /> Roof drauis --- Other <br /> Other ____ — <br /> CITV OF EVERETT LOCAL SALE9 TAX CODC IS 7106 <br /> II hereby certify Ihat I have read and exemined Ihis appiication and know ihe same to be true end correcl. All provisions ollaws and <br /> ' ordinances goveming Ihis type of work will be complied with whether specifiad herein or noL Tha gran�ing of a perm�t does nol presume <br /> lo grve au4iority to violate or cancel Ihe provision ol any other state or local law regulaling ccnsiruction o!ihe peAormance ot <br /> conslruction. Thal I am authonzed by the owner ol ihis pioperty lo periorm the work lor which epplication is made and I comply with the <br /> State Contra�tors Law 18 27 RCW and 29Fi200 W�C. <br /> �.-_..-1 ��J__� � '`�-�SL <br /> Sigrature ol OwriedContraclor/Aulhorized Agent Date <br /> - - ------- --- - - - -- � � <br />