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FCRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810 - FAX 425-257-8857 -ww�v.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM l� `aC� ,,.,jJ � <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �/ ? (/'�,�� /'.:/ e D.— ti '(�• • 4 h <br /> LEGAL LOT NO. BLOCK TRACT OR SUB�IVISION# <br /> D[SC. <br /> OWNER ADORE55 CITY/ZIP PHONE <br /> l�it �� ��/so��� (�� ���._�� /�if e !�i— �de„% ���a� `f2 S- 2�z-yo5 3 <br /> TENANT NAME CONTACT FOR P[RMIT PHONE <br /> E•MAIL <br /> -�GbNTFA�:TUR/ � A DRE I I HONE <br /> ,�y,�'.�l'l'••- ��i/rS �,5'r,v 360 / ��r�/,�'�- �l�`�b�"�/ <br /> CONTR.LICENSE# `' Q ��J�� '�J�' ��a�� <br /> ,�L��/• �/� ��1Z-/�L <br /> USE OF BUILDING HEAT SOURCE CONTRACT FRICE OF WORK <br /> 7 <br /> c� a <br /> ` p> �Eleclric ��Gas__Olher �j �� �/ � <br /> WORK DESCRIPTION <br /> ,�1��� ��i���,,•�� J`7 �Y���'�°� t�=�S �_`��-�'-�'��` �- <br /> PLUMBING MECHANICAL <br /> � NO. TYP[OF FI%TUR[OR IT[M NO. I TYPE OF FIXTURE QR ITEM <br /> I <br /> Tuilel NC- air handling units <br /> o.3mwi, 1 Forced air syslems <br /> Lavalory(wash basin) ��as piping <br /> Shower Waler healer <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dish�vasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Water heater Range hood <br /> _ Sink(service/badmop/elc.) Exhausl fan <br /> Dackflow preventer � Heal pump <br /> Urinal Unil heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeralion <br /> Grcasc lrap Woodslove <br /> Roof diains Olher <br /> Other <br /> I CITY OF EVENETT LOCAL SALES TAX CODE IS J705 <br /> iI hereby ceriti(y lhat I have read and examined this applicalion and know Ihe same lo be Irue and correcL All provisions ot Iaws and , <br /> � ordinaces govemin�lhis rype ot work will be complied wilh whelher speci(ied herein or noL The granling ol a permit does nol presume � <br /> � to give aulhori�y to violale or cancel�he provision of any o�her s�ale or local law re�ulaling consUuction or lhe peAormance of I <br /> I conslruclion.That I am aulhorized by the owner o(th s property to peAorm ihe work lor whlch applicalion is made and I comply wilh ihe <br /> Stale Coniraclo,ts Law 18.27 RCW and 296.200 WAC. <br /> �� ����. '! /' /C� - Z`j-G'� <br /> Signal re of OwnedConlractor/Authonzed Agenl Dale <br /> � <br /> � <br />