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��� �RMIT APPLICATi.,,� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> , , ,l 425-257-8810- FAX 425-257-8857 -www.everettwa.org �;�, � ,-� .� . �/ <br /> APPLICATIONS ARE ACCEPTED FRJM 8 AM TO 4 PM -DE81T& CREDIT C DS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D,p PERMIT M <br /> �.Cs4��IN0120 �L�Ot30'� OO�jOZ /� OSI�� JCI�� <br /> LEGA LOTNO. ELOCK TRACT <br /> DESC. <br /> OWNER ADURE55 CITYIZIP PHONE <br /> J�M rc�,� 12014 2c�� sr � �v�t�tr a� �HL5�o8 2852 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> S6v`lG%�C�•�a(��l "� `�'`1��7 �0�7 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> �K�t-c1Ur1" cot�srP-��� l201�' �..�'"'% S� �tt' `�'LS �2�2— <br /> CONTR.LICENSE K <br /> I�l�C-c'I �G6lb"It-Z I�- <br /> USE OF BUILD�NG I HEAT SO RCE CONTFtAC7 PRICE OF WORK <br /> � <br /> ���C�/ _[le iric 'as__Other ��� <br /> WORK DESCRIPTION / <br /> N�! Gor�stKUCt[oN • �o UrkC(5 t�.�.-t-�ql� . /` ' n" . <br /> �' , �� <br /> . , . , - � ' , , _ ' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet NC-air handling unils <br /> _ B2thtub Forced alr systems <br /> __ Lavatory(wash basin) ��� Gas pipin9 <br /> Shower Water hoatnr <br /> _ Kilchen sink 8 disposal , �� _ Gas fireplac� <br /> _ Dishwashor 1 �� Gas ranc�o <br /> Clolhes washer I Clothes dryer <br /> _ Laundry tray �� _ Rango hood <br /> __ Sink (service/baqmop/otc.r �) Exhaust fan <br /> = Backflow prevonter \ �V� Heal pump <br /> Urinal \ Unit healer <br /> __ Drinking Founlaln ...�� � �oiler <br /> Floor drain � Re(riporation <br /> _ Greaso trap Woodslove <br /> _ Roof drains / _ Other <br /> Othor <br /> CI OF EVERETT LOCAL SALES TN(CODE IS 7705 <br /> I horeby ceritify Ihal 1 have read and examin.d Ihis application and know Ihe samo to be true and conecl. All provislons of laws and <br /> ordinaces poveming lhis type ol work will 6 r.omplied with whother speci(iod heroin or not.Tho granting ol a permit does not presume <br /> to c�ive aulhorily to violato or cancol lhe pr ision of any othor stale or local law regulatinc�construclion or Ihe performanco of <br /> construction.Tha �u iorizod by the wnor of lhis property to perlorm Ihe work tor which applic.,llon is made and I comply wilh the <br /> Slato Co a L CW and 2 �.200 WAC. <br /> 10• 2 �05 <br /> Sipnature o w r/ onlractor/Authonzed Ac�ent Date �� <br /> � :�i _ <br />