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<br /> � PT�RMIT A,PPLICATIUN
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<br />���->` �� CITY OF EVERETT PERMIT SERVI�ES �
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<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br />�R;•��'. i 425-257-8810- FAX 425-257-8857 -www.everettwa.org (���(7 ��j
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<br />'''` APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM
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<br /> �`�"�� SITE ADDRESS PARCEL TAX I.D.# PERMIT#
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<br />��� �1�"�� � LEGAL LOTNO. BLOCK TRACT
<br /> c�4,` ' DESC. I i
<br />� �`> j OWNER ADORE55 CITY2IP PHONE � .Z�
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<br />� 5p - I TENANT NAME CIONTO�CT FOR PERMIT PHONc �
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<br /> `� �� CONTRACTOR ADDRcSS CITYfZIP PHONE ��,�
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<br />� CONTR.LICcNSE#
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<br />��'� I HEAT SOURCE CONTRkCT PRICE OF WORK
<br /> ..��; ,, USE OF BUILDING
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<br /> ' WORKDESCRIPTION �:.�y;•-1,_,_ LI-'j'G.�l C..��FS ��[-K.IL-� Jrl:�i b.`'� �`L`�-''
<br /> f��-la1 /�LL 1•�..ec SS�I��� �]J�� �..�n2v,
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<br />`r''' ' � PLUMBING MECHANICAL
<br /> ' NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I
<br /> Toilet � A/C-airhandlingunits ,
<br />`�'�����- BalhWb Forced air systems
<br />`��"'`�� — � Gas piping
<br /> � Lavalory(wash basin)
<br />��� �, � _ Shower _ Waterhealer
<br /> '. Kilchen sink&disposal _ Gas fireplace
<br /> .��. �' Dishwasher _ Gas ranae
<br />-`�� �' Clolhes washer _ Clo;hes dryer
<br /> Water heater _ Range hood
<br /> Sink(servicelbarlmoplelc.) Exhaust fan
<br /> BackOowpreventer _ Heatpump i=���:��
<br /> Urinal _ Unithealer ,:,���.
<br /> Drinking Founlam Boiler :� ��o`;�`)
<br /> Floordrain _ Refrigeralion ,,,�
<br /> Grease trap _ Woodslove R�-"".:^�
<br /> _ Roof dreins _ Other r.��,�
<br /> _ Other — �,% .
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<br /> I CIN OF EVERETT LOCAL SALES TAX CODE IS 3105
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<br /> ! I hereby ceritify that I have read and examined this application and know the same lo be lrue and correct. All provisions ef laws and
<br /> ordinaces yoveming this type of work will be complied with whelher specified herein or not.The granling of a permit does not presume
<br /> to give aul rity to violale or can I lhe provision of any olher state or local law regulating construction or the performance ot
<br /> co r,ti n.That i am au i by the owner ot lhis property ro per(orm the work for which applicalion is mado and I comply with ihe
<br /> ale C tractor Law .27 and 296200 WAC.
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<br /> Signature af wnedContractodAuthorized Ayent Date `I
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