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PErtMIT APPLICATIO�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTFD FROM D AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPT:D <br /> SITE ADDRESS PARCEL TAX I.D.S P MIT 0 <br /> ��U / 5��/jN SUII� l03 C <br /> LEGA� LGT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADORE55 GITY2IP PHONE <br /> (;�f�t� b�� ;t)��'�� l�%rGf,( ��i.'�i�iEii 3201 5r�ii�1 ✓���' �1;'fG� ��I� <br /> TENANT NAME CONTACT FOR PERMIT !•HONE <br /> �/a5- 739- Oa03 0 � <br /> �SPR�55o A�7Fi5/c� 1,o T_N� . h'O�v �. D�/17/c� [- /o ya�- e �o - roso Cc�c. <br /> CONTRACTOR ADORESS CITY2IP PI10NE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRAC7 PR�CE OF WORK <br /> L'���� ��� ���,�j _Electric �Gas_Other ��D��y� � <br /> (� <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE Oft ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet rVC–air handling units <br /> Bathwb Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Cblhr.s dryer <br /> Laundry tray _ Range hood <br /> Sirk(service/bar/mop;etc.) __ Exhaust fan <br /> BackOow prevenier _ Heat pump <br /> Unnal Unit heater <br /> � Dnnking Fountain Boiler <br /> Fiaor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> I — <br /> I CI7Y OF EVERETT LOCA�SALES TAX CODE IS 3105 <br /> � I hereby ceritify that I have read and ezamined ihis application and know the same to be irue and correct. All pmvisions of Iaws and <br /> ortlinaces governing lhis type of work wiil be complied with whether specfed herein or not.7he granting of a pertnit does not presume <br /> to give authont�;o violate or cancel the provision cf any other state or Iocai law regulating construction or the pertormance of <br /> const-uction.TfSet I am authorizetl by the owner of this property to per�orm the work for which application is made and I comply with the <br /> Slate Contractcrs Law 18.�7 C'�"J and 2°6200 WP.C. <br /> . ' ���. . �� � GLV� <br /> l� L . � � ; ��1�, �-�., _ r <br /> Signacure of wnenContractouAuthon<ed Agent i Da�e � � <br /> iv <br /> � <br />