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�—" <br /> � . , <br /> Pl.r�MIT APPLICATIG�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982Q1 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBlT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL l'AX I.D.!� PERMIT# <br /> 36�,5 ,; . on�, s-� 3 r��, ,, ,., .So�iZ - c� <br /> LEGA LOT NO. BLOCI� TRACT <br /> DESC. �r) .�G.v � (: � `�� '1aS S 5 Ac�C �Tl,,,f. <br /> OWNER ADORE55 CITY2IP PHONE <br /> � � � ��<�C ( {. *" �jJ� � <br /> _ -�� r��.u �' H�. ;, - ( C � ��� �� �� �I�a � �,�i aia- a�� <br /> TENANTNAME � CONTACTFOR PERMIT ' PHONE <br /> � ���I r��� � �r� ��c,,, 4n � I J���e.,� � vlo��v I ���5 ��� . �(c�.i�� <br /> CONTRACTOR !7 'U ^ ADDRE55 CITY2IP PHONE i S <br /> ,crr�� � �e p � � <br /> CONTR.LICENSE# �fA� NG(cllia,.. I�d• �d�r. :: �t��,�l a�yJ;l • �7C - P� %r <br /> 'JF_'(Y�J �LCJ ^�7 ( I^. <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> (') �_(d� ( I �°" Electric _Gas_Other I "�, ( '1 "i C) , n v <br /> r — <br /> WORKDESCRIPTION � n ���i�� �ll � ql�_�u+.J V1nv✓n�-(� wq�� �iqh -i-n {�� ���{C �G <br /> � `� u . <br /> �� 1 , '�,� a'. "I � f ��P ., � ; �n -i ,�-�.�. �� .iu^�.+$ <br /> � � I� � <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A!C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kiichen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> _ Clothes washer Clothea dryer <br /> Laundry tray Range hood <br /> Sink(service/b2dmop/etc.) Exha��st fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain 8oiler <br /> _ Floordrain Re(rigeration i <br /> Grease tr2p Woodstove <br /> Roof drains Other <br /> Cther <br /> I — � — <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> � I hereby ceritity that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> � ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br /> � to give authorry to violate or cancel the provision of any other state or local taw regulating construction o�the performance of <br /> ;.onstruction.Thet I am authorized by the owner of this property to perform the work for v�hich applir.ation i; made and I comply with the <br /> State Co�n t�ctors Law 18.27 RCW and 296200 WAC. <br /> � I <br /> �Cs-�-�� �ca�f�� �2- 3� ��y I <br /> Signature of Owner/Contractor! dhonzed Agent Date /L I <br />