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P�l�RMIT APPLICATIO�V <br /> CITY O�F EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— f-AX 425-257-8857—vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� � c�p�_p�+3 <br /> SITE ADDRESS I�j j�- �{L��j PARCEL TN(I.D.# PERMIT if <br /> �65a�- G � <br /> LEGAL LOTNO. BLOCK TRACT <br /> OESC. <br /> OWNER ADORE S CITY2IP P E <br /> 1�o.f t+�£'x►oE.�T 1�'.�c � 710 l -�+�}0�3 <br /> �a.�� �- ''''"`� �a�.�n- �.1a �' � tv�'(c��T <br /> TENANT NAME CONTACT FOR PER T PHONE <br /> �k1E. o.S �r�l�{,2 <br /> S- <br /> CONTRACTOR � �'�DDRESS�7 O' � CITY2IP PHONE �� <br /> CONTR.LICENSE# 1 � �h L���,��y f Q� � "D' � �/�p",���'(I�'�� � � <br /> V�w� —�FY!{I'C�� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �1� ���� '� I _Electric _Gas_Other �Z�j� �� <br /> WORK DESCRIPTION ����r � pn � <br /> q F�rtiv,��la�frqn • v�e��re� be w,�•rr.�l. <br /> 1�. � (� �d��� ���(�rr� f81 a�r-��. <br /> PLU BING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Balhtub Forced air systems <br /> Lavafory(wash basin) Gas p�pinc� <br /> Shower Waler heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry lray Range hood <br /> Sink(service/badmop/elc.) Exhaust fan <br /> Backtlow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodslove <br /> ! Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritify Ihat I have read and examined this application and know the same lo be lruo and correcL All provisions of laws and <br /> ordinaces governing lhis type o(work will be complied with whether specified herein or not.The granting oi a permit does not presume <br /> to give aulhority to violale or cancel the provision of any other state or local law regulating conslruction or the pedortnance of <br /> construction.That I am aulhorized by tho owner of Ihis property to pedorm the work for which applicalion is made and I comply with the <br /> Slato Contra rs�aw 18.27 RC and//29G.200 WAC. <br /> Y/ � Y/i.�'�'I'G{� ZJILN�� <br /> Signalure of�wne ntractor/Authorized Agent Date <br /> l <br />