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PE.IMIT APPLICATI��I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR S'T'REET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 3 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADORESS PARCEL TAX I.D.# PERMIT/ <br /> ' G r5t,,�ti MO�109-� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ITY21P PMONE <br /> l�t.�i/rran �u.1�j �OII( G{�ros�av�" C�t/Prolf ��01 `115-.��(s-l9Yb' <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> '" JLrt�orJfMuc a(SnohJ��� ����,� ya;-a�,- �a�o <br /> �V,I��u„ �/Nr�, <br />� CONTRACTOR ,`xr,�� >��y��� aF ADORE39 CITY2�P PHONE <br /> SrJ��rn�sti jy 8'd�� 'i'��aA�r.�J A/�ulC,��.•<� 98a�S ���'�0-iaS7� <br /> , C��� <br /> CONTR.LICENSE N SN�'�' D <br /> SCniOSS.�`� N <br /> USE OF BUILDINO I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> `,�,v15�P �P»�� �� IQ/S��n�<< ElecMc Gea Other I <br /> WORK DESCRIPTION <br /> RfMd✓C, an�+ Rrp�n�t Wa�.•r I-�r•r�fR" <br /> PLUMBING MECHANICAL <br /> N0. TYPe OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—alr handlinp uNls <br /> Bathtub Forced air syatema <br /> Lavetory(wash basin) Gas piping <br /> Shower � Water heater <br />' Ki:chen slnk 6 disposal Gas flreplace <br /> � Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink (servlcelbar/mop/etc.) Exhaust fan <br /> Backilow prevenler Heat pump <br /> Unnal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrlgeration <br /> Grease trap _ Woodetove <br /> Roof drains Olher <br /> iR Olher 1.�� <br /> CITY OF EVERETT LOCAL 9ALE9 7A%COOE 19 3105 <br /> � I hareby ceritih•that I have read and exanined this applicalion and know the same to 6e true and carred. Ail provielons of laws and <br /> ordinaces governing lhis type of work H�ill be complied wilh whelher specified hareln or not.The grenitng of a permit does not preaume <br /> to give authority to violate or carcel lhe provision of any other state or local law regulating conatrucUon or the perfortnance af <br /> construction. That I am authorizea hy the owner of this property to perform the work for which appllcation la mede and I comply with lhe <br /> Slate Conlractors La 1 27 VC and 296.200 WAC. <br /> I � ��..�� q/a,� <br /> ISig r wnen ontractori uthonzed gent ate <br />