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SITE ADORES <br />� �� '�rrr�1 <br />LEGAL LOTNO. <br />DI:SC. �_� <br />OWNER <br />E� cRMIT APPLICATI�. �l <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, FVERETT, WA 98201 <br />425-257-B810 — FAX 425-257-BBE7 — www.everettwa.org <br />APPLIC 4TIONS ARE ACCEPTGD FROM U O M TO 4 PM �,, �`) S�' ��� <br />'' �-�--1-- <br />BLOCR TFtACT <br />PARCEL TAX I.D. N <br />-2� <br />m�r�; �c�-� .�� -�--�q�f �c�t/E�ioa_ (�S�ie� 9��~ <br />TENANTNAME CONTACTFORPERMIT PHONE <br />I �'l�-�P1�t. l/Q/�ih��� �15-75�1-/S� <br />CONTRACTOR L. /)m,r-H jr �t ADURE55 CITY2IP PHON / 7O <br />11Q f' a ..���_ �_L�" [%�-�� ' � <br />CONTR.UCEN EI 9J�I�j�" ��-y���/Q� ��l,� �� <br />��m���,��Bo <br />USE OF BUILDING � HEAT SOURCE � CONTRACT PRIC[ OF WORK <br />WORK D SCc � RIPTION � <br />C�LJL�'i �'� � <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Levatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />clotnes washer <br />Leundry lrey <br />Sink (service/barhnop/etc ) <br />BeckOow preventer <br />Unnel <br />Drinking Fountain <br />Floor drain <br />Grease Irap <br />Roof drains <br />Other <br />Electric ✓ Gas Other <br />� <br />�- <br />N0. I TYPE OF FIXTURE OR ITEM <br />AIC - air hantlling unds <br />:� Forced eir systems <br />Gas piping <br />L. Water heeter <br />/ Gas hreplece <br />� Gas renge <br />J_ Clothes dryer <br />� Range hood <br />� Exhaust tan <br />__ Heat pump <br />Unit heater <br />' Boiler <br />RefrigaraGon <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL 9ALE8 TA% COOE 19 �106 <br />I hereby ceri6fy that I have read end exemmed this appllcation end know the seme lo be true end correct. All provisions of lews end <br />ordinacos goverNng this type of work will be complied with whether spedfied herein or nol. The grenting oi e permft does not presume <br />to give authoriry to violate or cancel Ihe provision ol any other state or local law reguletlng wnstniction or the performance of <br />construction Thet I em authoiized by the owner of this propeAy to pertartn Ihe wnrk for which apptication is mede and I comply wilh the <br />Slale Contra ors Law 1B27 R,r,yyend 29G20i1 WAC. <br />�%� f��ULr�_i'LC - ,P. % �o • D G� <br />