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PErtMIT APPLICATIG�� <br />(:lTY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT,'NA 98201 <br />425-257-8810 - FVJ( 425-257-8857 -• www.everettwa.ory <br />i5 -o <br />��7�� Z...� <br />APPLICA'fIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SiTE ADDRESS <br />% y l�clvc-crerze �vTc�. <br />LEGA LOT N0. � 6LOCI< I <br />DESC. ; <br />� �...--•_ <br />;1 �� �.,�e� 7�,� �1 � Q i e �=-�° s� <br />PAP.CEL TAX I.D. # <br />�!�� Oc��4/'7�DUu�ZS uL <br />TRACT <br />sti�� ��y ��� S� �3� <br />TENANT NAME .._ I CON7.4C7 FOR PERMIT <br />--�-----_._ ���_ � <br />� <br />y�oi� (4zs)N�1 iS3? <br />PHONE <br />CONTRACTOR �'�`��n' _�� ADORE55 i_ CITY2IP pIIONE <br />k ns�s��};-.,�� 2��2o tic ��1�-�� l`+aS)��3-<�s���ct <br />CONiR. LICENSE JI �.Ca by�o��ci \N j� c�'�OS � <br />I`1.i_� i�SC �' 9g ; N'�, � (4z�.)�,L- _ ��i�z «tl. <br />USE OF BUILDING I HEAT SOURr,E I CONTRACT PRICE OF WORK <br />_ � <br />_ Eleclric � Gas _ OLher <br />��27, /�,u - <br />WORKDESCRIPTION Co���.{���t;,,,� �S ne�... �1iS s�l�'.� '�;,,�I� <br />��14-��1�t (C<��c�c.'t�cP . -�-'�lc.��,c���� I°�t�1.��irlr R WCC�ANiC_�1I <br />J <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub , <br />Lavatory (wash ba�in) r.. <br />Shower <br />I<ilcher sink 8 disposal <br />�ishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urmal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />MECHANICAL <br />NO. � TYPE OF FIX7URE OR ITEM <br />A/G - air handling unils <br />Forced air systems <br />Gas piping <br />W3ter heater <br />Gas firaplace <br />Gas range <br />Clothes dryer <br />Rango'�ood <br />Exhaustfan �, <br />Heat pump <br />UNt heater <br />Boiler <br />Refrigeretian <br />Wcodstove <br />Othor / <br />CITY OF EYERETT LOCAL SALES TAX CO�E IS 3105 <br />I hereby ceritify that I h2ve read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinar.es governing this type o( wcrk wlll be complied wilh whelhar specified herein or noL The grant;�p of a permi! dces not prenume <br />to give authonN to violate or cancel the provision of any other stale or local law regulating ccnstruction or the performance ot <br />const; uction. TY�3[ I am authorized by the owner of this property to perform the work fqr which application is made and I comply wilh the <br />State Contractors Law 1c3.27 RCW and 296.200 WAC. <br />N.1:^ ._.� � �. - ���¢ f �y <br />, <br />Signature uf OwnenCentractonAuthonzed Ager,t ate �L. <br />� r .-,__ ,.: . <br />