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P`RMIT APPLICATII�N <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 70 4 PM �i 'ro�(��DI <br /> SITE ADDRESS, PARCEL TAX I.D.# PERMIT# �� <br /> -i1�.I S v-� . h\SI NO �n.�-� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADURE55 CITYIZIP PHONE <br /> \ ' <br /> �V �`SNIIJUrt271J ��ITII(. �-'�PNQC�',Atit'J�'� <br /> TENANTNAME CONTACTFORPERMIi PHONE <br /> �l jcci..tn /��z��SCW�ctS ��c.� �o� � S3z- 'Z`�oo <br /> CONTRACTOR,_ ADDRE55 CITY2IP PHONE <br /> `�nce�� L�,�n��c�us1�W,�Tion� 3yi<�- � (I G� �(� ST �ti-rnj 98/6� �� �3z 24c� <br /> CONTR.LICENSF M <br /> USE OF BUILDING HEAT SOURCE �ONTRACT PRICE OF WORK <br /> �L _Eleclric _Gas_Olher <br /> WORN DESCRIPTION �7`, ��C ` �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> � Toilcl NC—air handling uni�s <br /> Bathtub Forced air systems <br /> �. - Lava�ory(wash basin) _ Gas piping <br /> Showcr Water hoalar <br /> KitGien sink 8 disposal _ Gas lireplar.e <br /> Dishwashcr _ Gasrange <br /> � Clothes washor Clolhes dryar <br /> Walcr healer _ Rznge hood <br /> Sink(service/barlmoplelc.) _ Fxha�.�sl�dn <br /> B:+ckllow preventr.r _ Heat pump <br /> Urinal Uni�hea�er <br /> Drinkinc� Fountain Boilor <br /> � Floor drain _ Relriporation <br /> Grease Irap _ Woodslove <br /> Rool dra�ns Other <br /> Olhe� <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 7105 <br /> I here6y ceri�ify that I have read and examined Ihis applicalion and know�he same lo be�rue and correcl All provislons nt laws and <br /> ordinaces�oveminc�this type of work will be complied wiUi whelhor specilied herein or no� The granting of a permit Joes no�presuma <br /> to yivr, authority lo violate or cancol ihe provision o�any other slate or local law regulatiny construction or tho peAormance ol <br /> conslruclion. That I am authorized by Ihe owner ol this properly to perform Ihe work for which applir.ation Is mado and I comply wilh Ihe <br /> Sla�e Conlraclors L�v✓19.27 RCW and 29G.200 WAC. <br /> i <br /> Signaturyo� w er nUa or/Au orizedAgenl Dale <br /> i1 �—' <br />