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"1 -�0 -0`� <br /> PEi'MIT APPLICAI"ION <br /> CITY OF �J�RETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9f3201 <br /> 425-257-8810— �AX 425-257-8857 —wwv�.everettwa.org <br /> i APPI.ICAT''�NS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 'D l D � ,.�v.� ,�e� .�I,va �'v 7 �(o <br /> LEGAL LOTNO. BLOCK TRACT <br /> fIESC. <br /> OWNER ADORE55 CITY2IP PHONE I <br /> � ' 7 _ <br /> /5 ,'7�� /�� �� l�� l<;3 1=�-��;�����r� ����� i�� �� ��ri <br /> TENANT NAME CONTACT FOR PERMIT PH(INE <br /> / <br /> � �tc. ��(� %�,iA ![�,y Ii,r�•/ )fG' �1';�-357� <br /> CONTRACTOR /f��sj-f�������n ADORESS CITY2IP PHONL <br /> , �� 7c73 i�iG"� ,Lr;i7 �YiI �!i'S�:�`1/-�« <br /> CONTR.L�CENSE p �,� ��[� ��, ��yL��f <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> .����'� _Eleclric �� Gas_Other �`l����-�' � <br /> I <br /> WORI(DESCRIPTION <br /> y�, l���r ,�{ U M�� - �=r� -h-� <br /> , �'1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet `Z A/C—air handling units <br /> BatMob Forced air systems <br /> Lavatory(c.ash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas freplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> BackOoH•preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiter <br /> Floor drain Re(rigera�ion <br /> _ Grease trap Woodsrove <br /> _ Roof drains __;�_ Other ��TCI F�crA�ca;,/� <br /> Olher <br /> I —I — — <br /> CITY OF EVERETT LOCAL SALES TA:t CODE IS 3105 <br /> I hereby ceriti(y that I have read and examined ihis application and know tha same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work.will be complied wilh whether specifed herein or noL The granting of a permit does not presume <br /> to give authoriry to violate or cancel the provision of any other state or local law regulating construction or the pedormance of <br /> construction.That I am authorized by lhe owner of this property to pedorm Ihe wnrk for which application is made and I comply wilh the <br /> State Contractors Law 1827 RCW and 2962001'UAC. <br /> l <br /> I _���'��>�{ � (`J'C� <br /> � !< <br /> Signature o Owr.edC UaclodAuthorized Agent Dale <br /> ' I <br /> � _ <br />