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1 <br /> PE�RMIT APP�IGAT'IO��� <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 ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.C.# PERMIT# <br /> _ � _ 3q�r-bt (nl�a v �75� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OVdNER � ADDP,E55 CITf/Z�P PHONE <br /> ��� ���.� �t 1�C'z_, F��� �1���n�� N��S' - �i- a I <br /> TENANT NAME CONTACT FOR PERMIT , PHONE <br /> �7.v�P-Q1p�l� lJ�'l�l���> �4,'JfJ.�I �--- ��tJv�nN-� <br /> CONTRACTOR C v�ti. �����.� ADORE°a 1v��� b ITY/ZIP PHONE <br /> '",�.' �w�u�.,'� ua��-� -� 66 <br /> CONTR.LICENSE# �U�`1 l� n � "� ��� <br /> \\ /v �[F <br /> USE OF BUILDING — HEAT SOURCE I CONl'RACT PRICE OF WORK <br /> Electric ./Gas Other <br /> WORK�ESCRIPTION <br /> � C��� � � <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br />� _ Shower _ Waterheater <br /> Kitchen sink R disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> l.aundry trey Range hood <br /> Sirk(service/har/mop/etcJ Exhaust far. <br /> BackOow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trep Woodstove <br /> = Roof drains =I Other <br /> Other <br /> I <br /> � CITY OF EVERETT LOCAL SALES'fAX CODE IS 3105 <br /> � <br /> ; I hereby ceritify that I have read and examined this applicalion and know the same to be true and correct. All pru��isions cf laws and <br /> ordinaces governing this type of work Hill be complied wilh whether specified herein or not. The granting of a permit does not presume <br /> to give authonty to violate or cancel the provision of any other state or local law regulating consWction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> Stat Contractors Law 18.27 RCWI_and 296200 V�(AC. <br /> I�uL_ �fI�itN�-'7 nl �«—�`� <br /> Sign ure of OwnedC ntract qA !h`anzed Agent Date <br />