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/ <<,�, <br /> J ._ <br /> -- - _ _ _� <br /> PERMIT APPLICATION ' <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDl�R STR[LT, L=VL RE=TT, VVA 98201 <br /> 425-257-8810- FAX 425-257-8857 - �wrw everetlwa org <br /> I ,�`,�� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> I SITE ADDRESS �Z� �� ;�,'�• / PARCE�TAX I.D.# PERMI'f p <br /> ' y�r i� '� , 1 <�!s , , � ,. .;,.:. � � , h �5 � _� .� � iD �53 <br /> LCGAI LOT NO. BLOCN TRACT OR SUBDIVISION M <br /> 1 N SC <br /> OWNER AUDRESS GTY/LIP PMONE y1S� -- <br /> :r, , L; .(. ��f�ii.. /`l ;'� i. . �.. r ,i� /�'�, !: �r s.•ft �J,4':!'�-� _-3•Y7- Z4•9S� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE y<b --�.'��> - 3 j 1 I <br /> i.� f e!n�vn n.i 1-u� .i 1 3�i, �D� � <br /> (�:i t.,. . .r ��•.-� i.: . i. E-MAIL <br /> .i ,. .�i�, -��.' � , ",.�. . . � � ,��;i . ... .� /. ../ d ii, t . . .� �� 1: l��/� ��f�. /.i/y <br /> CONTR.LICENSE N � � � . � ���, � � <br /> USE OF BUILDING I — HE4T SOURCE CONTRACT PRICE OF WORK II <br /> [lectnc �`Gas Other � � ' <br /> ��5' G <br /> WORK DESCRIPTION , <br /> . � . ,. . . .�; . .. „ .. . , � <br /> PLUMBING --� MECHANICAL <br /> NO. TYPE OF FI%TURE OR IT[M NU. TYPE OF FI%TURE OR ITEM <br /> lodet NC-air handhn9 umis <br /> � Fairy��i��� 1_ Porceda�rsystems <br /> Lavalory(wash basln) Gas piping <br /> Shower Water heater <br /> Kdchen smk 8 dispnsal Gas fireplace <br /> � Dishwasher Gasrange <br /> Cblhes washer Gnthes dryer <br /> Water heater Renge hood <br /> Sink(5ervicePoarlmoplcic � Exhaus�fan <br /> �ackflow preveNer . Heat pump <br /> Unnal Und hcaler <br /> . Drmking founlain E3oiler <br /> Floor drain Refrigerahon <br /> Grease trap Woodstove <br /> I _ __ Rooldrains _ Other <br /> � ._ Olher_ _ —.- — — <br /> I CITY OF GVERETT LOCAL SALES TAX CODE IS J105 <br /> II hereby certity u�,d I have read anA examined this application and know Ihe saine to be Uue and correcl All piovrswns ol laws and <br /> ordinances govemmg ih�s lype of work will be complied wrth wheUier 5pecdied herem or not The gran6ng of a pem�it does nol presume <br /> � to give auttinrity lo wolate or cancel the p�ov�sion of any olher state or local law repidating construclion or Ihe performance of <br /> ' ronshuchon That I am authonzed by Iha owner ol Ihis property�o peAorm the work for which applicalion is made a�d I comply wdh Iha <br /> ��;tate Contractors Law 1A 2i RCW and 2�J6 200 WAC <br /> � <br /> I �ii_-��r: •.i r�'.rr. �'t•/ /l�i7 � / �L- . <br /> i ;:�gnature ol Owner/Conlrac�or/Aulhonzed Agen� Date I <br /> I � <br />