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� ----- r ------------ <br /> � ------ . <br /> --- - - --- -- _ _ <br /> PERMIT APPLICATION <br /> , CITY OF EVERETT P�RMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT. WA 98201 <br /> 425-257-8870 - FAX 425-257-8857 -www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDR CARDS ARE NOT ACCEPTED <br /> -��--�- -- - -----�— f/.+2�� —PARCEL TAX I.D.k ---- —._. . . _- - �- -P� i IM�S/G�Z--- , <br /> SITEA�R�S �/��J� /� . . �.._.— I . O I 'i <br /> V l_e� �G ��' <br /> i <br /> I F(:Al LOT NO. OLOCK TRACT <br /> DFSC. .1� <br /> OWNER ADDRESS CITY2IP PMON / -� <br /> GciAit/ �r.��9�� � l 3a 1 ���' ���� /YIT(�1',�`�i�— — � <br /> -�'T NAN AME / ;, . �" CONTACT FOROERMIT PNONE � <br /> CONT�� r,��� �-,m ��������yy y,�5 ,�5y y9/� <br /> TO ��J�1�'�" �/ � DDRESS /� .l[v"�'�a" PHONE 7 <br /> -�,�� �.S��y�� <br /> CONTR.LICENSE/ �1:���H�����// <br /> f/C �` <br /> USE OF NG HEAT SOURCE CONTRACT PRICE OF WORK <br /> _ I��a�/c l��s/K�,� ' <br /> _ElccMc_XGas__-Other �4� <br /> WORK DESCR�PTION <br /> �,t jj-�p',l� �v'� ��u/� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet . _ A/G--air hand6ng unds <br /> Bathtub __ forced air systems <br /> . . . I_avalory(wash besin) - _ Gns piping <br /> Shower __ Water heater <br /> Kitchen smk 8 disposal .____ Gas firepiace <br /> Dishwasher Ges rango <br /> C�OIIIPS Wfl4i1Cf Clothes dryer <br /> �---- Laundry Iray --- Range hoai <br /> Smk(service/tar/mop/e�c.) Exhaust fxn <br /> II Backflow prevenler _ J Heat pump <br /> Urinal , _ Unit hen�er <br /> Drinking Foun�ain ____ ���Q� <br /> � FlnorArain ___ Reingeration <br /> Grense Irap ___ Woodstove <br /> I RoofArains '___ Olher_____ <br /> I Othor . _ .. ._ . _ ___ <br /> I - � ----- - � - -- <br /> . .- ---..------ ---- -�-� ---. . . ...---�------- <br /> i <br /> � ------- -- <br /> ' CITY OF EVERETT LOCAL 6ALES TAX COOE IS J105 <br /> II heroby ceritily Ihat I haw read and�zamined Ihi:application and know Ihe same to be lme�nd wrrect. All pmvisons ol laws and <br /> ordinaces gcvnming Ihis type of work wlll br,comp6ed wtlh wholhm spenhod heran or not. Tha granting ol u pormil doos nol pr¢sume <br /> lo grve authonty lo wolate or nc,I e prowsion of any other state or local law regulating construclron or No pedormance of <br /> constnir,lio . T hat I am,y�ul ntc y Ihe owncr of this pruparty to{xirform Ihe work lor which nppllcalion is made and I comply with the <br /> Smte Ger .tors La 1N .7 and 296200 WAC. <br /> � -��� _ ��/.� O.S <br /> I Sic�n urr.of OwncilCn rec r uthorved gen� ate <br /> J <br />