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PERMIT APPLIC/�TION <br /> CITY OF EVERETT PERMI'T SERVICES <br /> 3200 CEDAR STREET, EVERE'fT, WA 98201 <br /> 425-257-8810- FAX 425-�57-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEP'fEU FROM 8 AM �O 4 PM <br /> S�TE ADDRESS PARCEL TAX I.D.p PERMIT If <br /> '� `/ � k ' <br /> I LEGAL lOT NO. BLOCK TRACT OR SUBOIVISION N <br /> DESC. I I <br /> OWNER ADORE55 CITY2IP PHONE <br /> i4 n�N McRI�AN Z YZ 7 4�,be �v/,e6?' �/zs�- _ �-77'�el <br /> TEI:`NT NAME CONTACT FOR PERMIT PHONE Q <br /> _Z'��A�— ����'�° N E-M1:AII �� �?D'3Y�CJ <br /> ivo,eosr�.�M i�WTi�v , �=/��ny ,�c�,�E <br /> CONTR.LICENSE k <br /> No,e.�o�•�YA 97S'/t/� v7/7 g7r'`Nue � �vt�z90 y'�s-3�3s�`/�2`�_ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � <br /> /�� _Eleclric �Gas_Other � ^� "n <br /> iC L `�D�.� <br /> WORK DESCRIPTION ✓� L��G ��,eiu�E �`//µ�(� Ou'� I <br /> �/{C.0 �. <br /> I PLUMBING MECHANICAL I <br /> INO. TYPE OF FIXTUF2E OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> Toilet AIC— air handlinc� units <br /> i - g����i���� = Forced air systems <br /> Lavalory I�vash basin) Gas piping <br /> i Shower Waler hoater <br /> kilchen sink 8 Aisposal Gas lireplace <br /> Dishwashcr Gas range <br /> Clothes washer Clothes Jry�+r <br /> Water healcr Ran9e ho�-d <br /> Sinh(scrvicelbadmoplr.fc.) Eahaus�fan <br /> 8ackllow preventer Heat pump <br /> Urinal Unil hcaler <br /> Dnnkina Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trep Woodstove <br /> � _ R�ol drains _ Othor <br /> I _ Olher_ _.._ .. — . <br /> I �-- - --- — — _ . <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> II horeby contity ihat I hava;ead and examineA this appLcalion and know tho same to be true and correct. All provisions of laws and <br /> ordinaces�oveming this type o(work will be complied wilh whether speci(ied herein or nol.Tho granting �(a permil does not presume <br /> ito give aulhority lo violatr,or cancel the pwvisiun o�any olher stale or local law re9ulaBny conslmction or lhe perlormanca of <br /> construction.Th21 I am authoriz�d Gy lhe owner of ihis property�o porform Ihe work for which appliwlion is made antl I comply wilh the <br /> , Slale Conlractors Law 18.27 RC�N and 296. AC. � <br /> ♦--� �... � .—� .��, _/ �/-y�O�i i <br /> L ��u: l <br /> Signatu Owner/CoNractorlAuth:rized Agenl Date <br /> � � <br /> i � <br /> I . . . . _ . _ .._. ._ ._.. _ __----___------- � <br />