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..a--� . <br /> PEKMIT APPLICATIOIv <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.M PERM�T# <br /> -, , _..� ,+ C�, ;�.., �. R�� � B�<I� G 20 3if�9i� 1 ��'U , -GL�7 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORE55 CITYIZIP PHONE <br /> �Va'rr '� 1-;I�- ll ) �-�-(' � 'Y� �l� i�ct .St / �' ��. , lirr� l{ � ��- ) �i+ �5i7Jt.�i.; ; '�`/6 <br /> TENANT NAME CONTACT FOR PERMIT PHON3 <br /> < < <br /> S�� n�rc� ��J<� s <c/Zs) l�'�-s ,00 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> /��S, le ���.1�'/�' r, /75�z R���hcll l.Ur_�,tiC ��lc1� <br /> CONTR.LICENSE N <br /> liv.si t e� �lsS R�, 13, +h� �l �,.�� 95ci1 (`-�z5) '/8 `7-J'iao <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PR�CE OF WORK <br /> �� '� . a ���* ��� _Eleddc _Gas_Other <br /> WORK DESCRIPTION <br /> Z C <br /> (i<'�1�2 �.�r �� n�-i ��r ���i�CF C��" !` �S �� t���.' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilot A/C-air handling unils <br /> Balhtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Walerhnater <br /> Kitrhan sink 8 disposal _ Gas freplaco <br /> Dishwasher _ Gasrange <br /> Cbthes washar _ Clolhes dryor <br /> W2tor heater Range hood <br /> Sink(service/banmop/otc.) _ Exhausl(an <br /> Backllow prevonter _ Heat pump <br /> Urinal Unil healor <br /> Drinking Fountain Boilor <br /> I _ Floor drain _ Refrigeration <br /> Grease Irap _ Woodstove <br /> Rool drains Olher <br /> Other __ — <br /> —I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritily that I havo read and axamined this applicalion and know Ihe samo to be truo and conect. AI�provisions o(laws and <br /> ordinaces governing ihis type of work will be complieJ with who�her specifiQd herein or nol.The granling ot a permit doos nol presume <br /> to gl+e auUiority to violate or cancet the provision ol any olhor stale or local law regulating consWction or the poAormance ol <br /> construction. Thal I am authorizod by the owner ol lhis property to perform the work for which applicalion is mado and I comply with the <br /> Slate CoMractors Law 18.27 RCW and 29fi.200 WAC. <br /> Clr�� �, „ ��, � G� .� 0.� 3 �- �4 <br /> Signature of Owner/Cuntractor/Authorized genl Date <br />