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PErtMIT APPLICATIOIv <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERET'�,WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM (.�� �.-O � <br /> SITE ADDRESS PARCEL TAX�.D.# P RMIT# <br /> � J�� ���� -����� / <br /> LEGAL LOTNO. � BLOCK TRACT <br /> DESC. <br /> OWNER ����f� ADORE55 CITY2IP PHONE <br /> TENANT NAME / CONTACT FOR PERMIT PHONE <br /> ;,u:l� �,i �`/� �ti„�`���'� <br /> CONTRACTOR AD�RESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> ,it�� 7�� �-�•�/,Gy /iVC-" <br /> �V'rloTT LvN <�b?o/ �LrLS- ����- c�SyU <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WOnv <br /> _Electric �,Gas_Olher <br /> WORK DESCRIPTION <br /> -� /',�GZ(CL!/-� SL� <L� <br /> � � / <br /> � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C–air handling unils <br /> Dalhtub Forced air systems <br /> Lavalory(wasli basin) _ Gas piping <br /> Shower Water healer <br /> Kitchen sink 8,disposal � _ Gas fireplacc <br /> _ Dishwasher 7 L' _ Gasrango <br /> Clothos washor G _ Cloqies drycr <br /> _ Waterhealer �y� _ Range hood <br /> Sink(servicelbadmop/elc.) (/ _ C-xhausl fan <br /> _ Backflow prevenler /� _ Heatpump <br /> _ Urinal ,�f�-- _ Unit healer <br /> Drinking Fountain � � _ Boiler <br /> Floor drain Refrigeralion <br /> Groase Irap ' _ Woodslove <br /> Roof drain _ Other <br /> Other �� l'-P.:�i' Gti /�C. '"�'� — <br /> - �. ��'✓� <br /> - , - <br /> CITY OF EVERETT LOCAL SALL3 TAX CODE IS 3705 <br /> I heroby coritify thal i havo read and examined lhis applicalion and knoH lhe same to be lruo and corcect. All provisions of laws and <br /> ordinaces c�oveminc� lhis lypo o(work will be complied wilh whelher specifiod herein or not.The granling of a permit does not presumo <br /> to give authority to vioiate or cancel Ihe provision of any olher stato or local law regulaling consWction or tho per(ormance of <br /> construction.That I am authorized by Ihe owner o(lhis property to perform lhe work for which applicalion is made and I comply with tho <br /> Stato Contractors law 1827 RCW and 29G.200 WAC. <br /> �'�f/it �T �.71,G( '7'��9 `d� <br /> SignaWro of OwneriContraclorlAuthonzed Agenl Date <br />