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� P��MIT APPLICATIO�J <br /> �+�FY OF EVERETT PERMIT SERVICES i <br /> 3200 CEC.aR STREET, 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 8 CREDIT CARDS ARE NOT ACCEPTi°L'� <br /> SITE ADDRESS PARCEL TAX I.D.# P�E�{tMIT# <br /> .� � �20 C�frk-rs C�v _3 ���-�765- Lh�?_���D �:.. �� I� - D/ � <br /> LEGA LOTNO. BLOCK TRACT lLrec�-O�o �.� VcL�'•uY. �t o< <� F«9t 11.D Su.�4c4 <br /> G <br /> DESC. .�.-� ) b.s �UCltk7� L�I�J O S 'SrAtl�3i7�v il�C[u17�� D �1AT�f�e�cc <br /> , <br /> OWNER ADORE55 CITY2IP PHO <br /> !< 71c SS%�7�Z /;LtSSi.c��S 1 LL /YfilS i/> '� I'L ,c✓� /r"�2i1(ff�� lc)a �f�c�33 <br /> TENAhT NAME CONTACT FOR PERA7IT PHONE <br /> /�i,�,C L1- ..�� 5'aS= 8�a - ��1��y <br /> CONTRqCTOR d�+� ADDRESS S�, rt=A CIlY21P PHONE <br /> �/�bYG�nns7-S�n f�hnN /3 �G,� d[v�=��.�.r ;�-�� Sr. ��t �^ - 7 9Y-b,;zyi <br /> CON LICENS (�� /• ;�qQt�'�L.00� LcJh-• �j�J-7�-- <br /> �c�.f ��j�z,w�'t�J l�'��-� <br /> USE OF B ILDING L HEAT SOURCE CONTRACT PRICE OF WORK <br /> � - ,/I �,��� <br /> ^.� ��� � Electnc �Gas Other Y� <br /> t� <br /> WORK D� IPTION �� C�� � � I <br /> T <br /> ��� � �- ������.e ��.e,� .���� <br /> � �� <br /> PLUMBING MECHANICAL <br /> INO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Tcilet A/C—air handling units <br /> Bathtub I_� Forcedairsystems <br /> � Lavatory(wash basin) Gas piping <br /> � Shower bVater heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> / Dishwasher Gas range <br /> i � Clothes washer Clothes dryer � <br /> i Laundry tray (_ Range hood i <br /> � Sink (service/bar/mop/etc.) � Exhaust fan <br /> _ Backflow preventer _ Heat pump I <br /> �� Urinal Unit heater <br /> ' Drinking Founlain _ Boiler j <br /> � Fioor drain Refrigeration I <br /> _ Grease trep Woodstove I <br /> _ Roof drains _ Other I <br /> Other <br /> I <br /> I <br /> CITY OF EVERETT IOCAI SALES TAX CODE IS 3105 � <br /> I hereby ceritify that I ha��e read and examined;his application and know;he same to de true and correct. All provisions of laws and I <br /> crdinaces governing this type o(�.verk•.vtll be complied with whetiter specified herein or not.The granting of a permit does not presume <br /> to giv uthority ro vio�te or cancel`t�ie,�rovision of any other str:te or Iocal law regulating consiruction or the performance of <br /> con truCtiorv. That t�a� authorized by�ihe ew�neraf;his pr p y:u perform the work for which application is maGe and I comply with the <br /> St Ct�nt��eto�s L ri7¢� t���ar�� ���_� <br /> ts��� � , �Q l�� ��al�O� <br /> � ,� , .� � � <br /> Signatur c wnerr o tractouAuthonz ,d;4gEn C Date � I <br /> �L � <br />