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P`tRMIT APPLICATIC,r►I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEUAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettv�a.org <br /> APFLICATIONS ARF ACCEPTED FROM 8 AM 70 4 PM C�` ��` �� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT <br /> ,,2�.�S Gol� i��l�Y ��� � <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> �ESC. <br /> OWNER ADORE55 CINl21P PHONE <br /> f��20.-��. ,„ /��a�.,� 28 �5 C o l� y r'✓. cJ.s �s3.xz- <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> f 2��-�'1�r5_2 �J.lf/JL J�✓� P/f-I��L.G� E-MA� -�'S � ' /II� <br /> CONTRACTOR ADDRESS ITYIZI PHO <br /> Gr��s.{ n�o-�-fC...4s�F �s3�o � �� �tiY p-� 3�.,Cc. ,�?o�y�.,.1/ 3co -6sr- ��i8 <br /> CONTR.LICENSE N �A 17f27( <br /> USF OF BUILDING HEAT SOURCE CONjRACT PRICE OF WORK <br /> c p� <br /> �..�.�, � �L _Eleclric �Gas_Other p Q�i� �U <br /> WORK DESCRIPTION / <br /> �',,. ,'(c� �F- ,�o �,. .� (�s , r....o c�oc.. ,y Sss,—, �(, s S <br /> PLUMBING MECHANICA.L <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling unils <br /> Balhlub Forced air syslems <br /> Lavatory(wash basin) Gas pipinc� <br /> Shower VValer heater <br /> Kilchen sink&disposal Gas lireplace <br /> Dishwasher Gas ranc�e <br /> Clothes washer Clolhes dryer <br /> Waler heater Rattge hood <br /> Sink(service/barlmoplelc.) Ezhaust tan <br />, �ackflaw prevenler Heal pump <br /> Urinal Unil healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodslcve <br /> Roo(drains Other <br /> Other <br /> CITY Of-EVERETT LOCAL SALES TAX CODE IS 3705 <br /> �hereby ceriG(y thal I have read and examined lhis applir,alion and know the same to be true and correcL All provisions ol laws and <br /> ordinaces goveming this type ot work will be complied wilh whether specified herein or not.The granting of a pertnit does nol presume <br /> lo give aulhorily lo violale or can el Ihe,{��i�ion o(any olher state or local law regulatin�construclion or tho peAormance of <br /> construelion.Thal I am aulhorize� the �vner of this property lo perform lho work for which application is made and I comply with the <br /> ��St teC �lractotsle 1� 27 RCW�n�6.200 WAC. <br /> � �� � - ( 7 - O � <br /> Signalure o(�wfSedConlractorlAuthorized Agent Date l/,L <br />