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-- <br /> PERMIT ApPLICATION <br /> I CITY OF EVERETT PERMIT SERUICES <br /> 3200 CEDAR STREET, EVcRETT, WA 982U1 <br /> 425-257-8810 - FAX 425-257-SII57-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PA9 <br /> SiTE ADDRESS �i PARCEL TAX I.D.# PERMIT# <br /> �� �0�, ,` ; � �G�DZ •�C�Z <br /> LEGAL LOT M0. BLOCK TRACT OR SUBJIVISION# <br /> DESC. — _ <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> TENANT NAME CONT CT FOR PERMIT PHONE <br /> 4 u <br /> �,�� ,�yy1 �Y'L �iGS T/� e•Mni� _ <br /> CONTRACTOR� .L ADORES� CITYy/ � PHONE <br /> I ;��v�i /„��U!'J7� �cJ/`"' r'.G,' Ct�j�% Y;i,,�,��� ";:;5-<"��-,Y�'br <br /> I CONTR.LICENSE# ( � <br /> � �U� ��- ,���3�� s� � y,�� yr5 ����� <br /> IUSE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � � � �j(� ���tG� �Eleclric _Gas_Olher ���� 5L� `�' T�� <br /> -� — <br /> WORK DESCRIPTION ��I ��i�/ <br /> � b <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilct A/C—air handling unils <br /> Ballriub forced air systems <br /> � Lavatory(wash basin) _ Gas pipinc� <br /> Shower W ater heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas ranye <br /> Clothes washer Clolhes dryer <br /> Waler healer Range hood <br /> Sink(servicelbadmop/etc.) _ Exhaust(an <br /> Backflow prevenle. _ 11�at pump <br /> Urinal Unit heater <br /> Drinkiny Fcunlain . _ Boiler <br /> � Floo�drain _ Refri9eration <br /> Grease trap _ Woodstove <br /> Roo(dreins � ' _ Other <br /> _1— � — <br /> Other� �c� '��r'r,rht,� 5n�,� <br /> f <br /> CITY OF EVERETT LOC,�L SALES TAX CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined this application and know lhe same lo be true and correct. All provisions of laws and <br /> ordinaces governing this lype o(work will be complied with whelher speci(ied herein or not.The granling of a permil does not presume <br /> to�ive authority lo violale or cancel the provision o(any other stale or local law regulatin9 conslruclion or lhe peAormance of <br /> wnsUuction. That I am aulhorized by lhe owner of this property lo per(orm the work(or which application is made and I comply with the <br /> Stale Conlraclors,L��v 18.2 �W pd 2�J6200 WAC. . <br /> � '/��-�� �/i��'' <br /> ���_ � <br /> SignaWre o(OwnedContractodAuthonzed Agent Dale <br />