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PERMIT APPLICATION <br />CtTY ()F EV�RETT PERMIT SERVICES <br />3200 CEDAR STREE7, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-$857 — w�.vw.everettwa.org <br />APPLlCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />j�oz Sr F�`c�7'fnn�'U.w'% <br />LOT�:O. � BLOCK � TRACT <br />PARCEL TAX I.D. # <br /># <br />-�v <br />DESC.r I f <br />OWNER ADURE55 CIl'tlDP PHONE � <br />� N�:uri�r' <C4�����5�?— <br />S-c.,r,�Fr-Sr w. 9'343 Vur.f �crILM/W P'V;. 3w �•'Fcku�,� �Iz4c., o'7u� <br />TENANT NAME CONTACT FOR PERMIT PHOHE <br />�'-.v; +•rc�af�2ys I w��Vl� C,�. C3lo)3L�; 6"'��u �C �r.2 <br />CONTRACTORUT� g= 0�-v-��oco •` ADDFESS <br />CONTR.UCENSE# ��/V��� �YjJJ <br />J <br />USE OF BUILDING <br />/v� G �Li1��T I !� G <br />HEATSOURCE <br />✓ Electric _Gas_Other <br />CITY2IP PHONE <br />CON7RACT PR;CE OF WORK <br />WORK DESCRIPTION <br />I�Jr�Z1u2/�Li Cn.�^Tc.�r� 'FArL .SrG�� t f5M2�'i-yS R-Er�t��*U�ti� <br />NO. I TYPE �F FIXTURE OR ITER1 <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Showe� <br />Kitchen sink 8 disposai <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbadmop/etc.) <br />Backflow preventer <br />Urinal <br />Driniting Fountain <br />Floor drain <br />Greas= trap <br />Roof drains <br />Other __._. <br />NO. I NPE OF FIXTllRE OR ITEA7 <br />AIC — air hardling unds <br />Forced air systems <br />Gas piping <br />Wat=r heater <br />Gas fireplace <br />Gas range <br />Ciothes dryer <br />Rang= hood <br />E�chaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refigeration <br />Woodstave <br />CITY OF EVERETT LOCAL SALES TA7C CODE IS 3105 <br />I hereby ceritity Uiat I havz read and examined Liis applicaUon and know tl�e same to 6e Vue and correct F!l provisions-af la�4s and <br />ordinaces goveming this type of work vnll be complied u�ith �vhether specified herein or not. The granting of a permit�does not presume <br />to give authority to violate or cancel the prorision of any otiier state or bcal law regulating construction or the performance of <br />construction. That I am auffiorized by tlie owner of this properry to perform ihe �vork for which application is mad= and I compty K�th ihe <br />StateContractorsLaw1827RCWand29b.200WAC. �:�,,,,,wuln.E���,�y,�,�{� (1�,�N(...!(7WUf%�I�L✓�:L• <br />