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PEkMIT APPLiCATION <br /> "�Y 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 5�� 3 �J� <br /> SITE ADDRESS � ��' PARCEL TAX I.D. # PERM T# <br /> �J�,� ; � �� /_��� plo�5 - 0�� <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> D[SC. <br /> XWN R ADDRESS kl ��, �` CITY/ZIP PHONE <br /> ��N/�!7 �. ��Lr��/ /JI� J� '� S�- `l�'�lD/ ���J9 - ��I �IS <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> I _- %'�,,,�..� ���c��c <br /> E-MAIL <br /> CUNTRACTOR ADORE55 CI"fYIZIP PHONE <br /> � <br /> �a,� G�.. � � ��t�/� <br /> CONTR. LICENSE# I, n rr/��G� /��/�v� <br /> rt % <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> il <br /> b <br /> ��,-� ,��) _Eleclric _Gas_Olher <br /> WORK DESCRIPTION <br /> ��7 � G1''� <br /> 1����G7C:/� � � �-yl•w�f_� <br /> t <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FIXTURF OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C -aIr hondling units <br /> Ba1hWb Forced 'air systems <br /> Lava�ory (wash basin) Gas pipi��� <br /> � Shower _ Waler h�ater <br /> Kitchen aink & disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clo�hes washer . Clo�hes dryer <br /> Water heater Ranye hood <br /> oink (service/badmoplelc.) _ Exhaust fan ; <br /> Backflo�v preventer Heat pump <br /> Urinal Unit healer . <br /> Drinking FouNain _ Boiler <br /> Floor drain Re(rigeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have re2d and examined Ihis application and know Ihe same l0 6e irue and correcL All provisions of laws and <br /> ordinances goveming�hls type of work will be complied with whether specified herein or not The granting of a permit does not presume <br /> �o give authority to violale or cancel the provision of any other state or loeal law regulating consiruclion or ihe performance of <br /> conslruction.Thal I am aulhorized by the owner of this property to perform!he work tor which applicalion is made and I comply with the <br /> Sla�e Coniractors Law 1827 RCW and 2962001,NAC. <br /> � � `-� -�a <br /> I� �:. �,� ��,1�= �� ������i�e� .��� <br /> Signature ot OwnedConlractor/Authorized Agen Dale <br />