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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-885'-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM `) - q - /C7 <br /> SITE ADDRESS PARCEL TAX I.D.p PERMIT# <br /> f— �� �e�[? S'� c( ' � —OC�'� <br /> LEGA LO NO. BLOCK TRACT OR S�ON p <br /> DESC. <br /> OWNER '/ ADORE55 CITYIZIP PHONE <br /> � ,��1 I (� �'�� ��� l�UC� L,.� Ki��- � •����/�' /U CC� � <br /> TE ANT NAME CONTACT FOR PERMIT � PH NE <br /> � y� �a`� �3 �� <br /> E� AIL <br /> S'l� ��- --- _-----�iTi6k�g— � aA�-- <br /> CONTR. LIC[NSE p <br /> USE OF BUILDING ---� — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eledric _Gas__O�her � <br /> WORK DESCRIPTION <br /> l�f'k) l-C/ !f? �-(.t �C �1 f�' _. <br /> PLUM9ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet NC –air handling unils <br /> �ath�ub _ Porced air sys�ems <br /> I_avatory(wash basin) _ Gas piping <br /> Showr.r __ Water heater <br /> Kitchcn sink &disposal ___ Gas fireplace <br /> Dishwasher _ Gas ranye <br /> Clothes washer _ Clothes dryer <br /> ---- Waler heatcr --_ Ranye hood <br /> � Sink (servree/barhnop/elc.) ___ [xhausl fan <br /> �- -- f�ackllow prevenler -- Heat pump <br /> � Urinal _ Unit hea�er <br /> Urinking Poun�ain _ _ E3oiler <br /> 1=loordrain _ Refrigera�ion <br /> Grease Irap ___ Woodstove <br /> Rool drains Other__ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 7105 <br /> I hereby cerGly Ih�t I have read�nd examined this applicetion nnd know Ihe same lo be true and correct. All provislons of laws and <br /> oidinances oovmning�his type uf work wdl be complied wilh whr.ther specified herein or not. The granting of a permit does nol presume <br /> lo give aidhonty to violale or cancel Ihe provision ol any other sla�e or local 12w regulating consUuclion or the performance o( <br /> conslruclion. I hal I am authorized by Ihe owner ol lhis pmpeAy lo perform Ihe work lor which application is made end I compiy wilh the <br /> State Contractors Lew 18 27 RGW and 29�200 WAC. <br /> �.�.— I � , '�- " %��i r �� <br /> SignaWre of OwnedConiractor/Aidhoriz��gent Da e <br />