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r <br /> I PERMIT APPLI�ATION <br /> � , CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> �/ � 425-257-8810- FAX 425-257-8557—w,vw.everettwa.org <br /> `, I• <br /> APpLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - CEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> yS�ITE A,D�DRESS ��'�'� /O�/'S PARCEL i AX I.D.p P/��t MIT'Y/. <br /> t�+� �y� �Y��E:_ �VE��.G"f�l �1f1 IBOJ�J�<;e�ocFioc�� �/oo I L.� 7�7 �'� <br /> LEGnL LOTNO. BLOCK TRACT <br /> DESC. E. .� L+Z � C, �J-LVG—IZ i.-Pc� V�t�I <br /> OWNER ADORE55 CITYILP PHONE <br /> �, �R �-�v�M�'i c��5 I��w'f�V�. N.E7�h� ;<�wu�o,,,vR 9�;0-�;, 4zs_£�z�_qq <br /> 7ENANTNPIAE CONTACTFORPERMIT PNONE r-�x y ��I• <br /> � �'��-C. � ��G?�C C�� �''�- hli��/LTl-- qz�_E�o-6fo 8 �� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> �-�=i v�Esr c�sr. �•��P� 353.�i, A�[s�a-ror�, v�A qgzzs qzs_�sr�-9'6�I6 <br /> CONTR.LICERSE tl P��L�=����C• ��j T� <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��Ep7.tP�L- o�FSF�S <br /> Eledric �Gas Other � ���(po�poc�• �O <br /> WORK DESCRIPTION <br /> � l�'�' /�{6P2[l�Ir o�FXCG—� �j./Ea.0 C'oNST(LUGlS:+'�1 • -��d.r <br /> �-� a-,C.e.�,� � ��'C� —D 3 �. <br /> PLU BING MECHANICAL <br /> N0. TYPE OF FI%TURE 6R ITEM NO. TYPE O°FIXTURF ,^„�„EM <br /> _ Toilet A/C—airhandlingunits <br /> _ Bathtub Forced air systems <br /> _ lavatory(wash basin) Gas i in <br /> Shower — pp 9 <br /> — Water heater <br /> _ Kitchen sink&disposal � Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/badmop/etc.) Exhauslfan <br /> _ BackFlow preventer Heat pump <br /> _ Urinal Unit heater <br /> Drinking Fountain Bailer <br /> _ Floor drain Refrigeretion <br /> _ Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS�105 <br /> I hereby ceritify that I have read and examined ihis application and know the same to be irue and correct. All provisions af laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granling of a permit does not presume <br /> to give authority to vioiate or cancel the provision of any other state or local law regulating construction or the perfarmance of <br /> conslruction. That I am authorized by the owner of this property to perform the work(or which application is made and I comply with the <br /> — Slate Co rec rs Law 18.2?RCW an 96.200 WAC. <br /> .k'��'' % G� .:>�/14/0 <br /> Si na u of wner/ ontrac!or/ uth zetl Agent Date <br /> I <br /> ��L <br />