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SITE ADC?ESS <br />;�o ,�o`rr .ov& <br />LE� LOT NO. <br />T\`t/T'f-I CaLL:�� <br />F-cRIV�IT APPLICATf� ''�i <br />CITY OF EVERETT PERIl�'iIT SE�- �CES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - vdww.everetlwaorg <br />APPLICATIONS ARE ACCEPTED FROM 8 A�11 TO 4 PM lp -/O <br />PARCEL TAX I.D. # PERMIT # <br />�i 7/l� '/� <br />�LOCK TRACT OR SUBDIVISIUN # <br />'7i� N�Yr .ov£: �u4:�!���T, qg2�; YZS-z36-ya6? <br />TENANTNAME CONTACTFORPERMIT PYONE I <br />I <br />K�.l7N �JLLo� E•MAIL�IGOI�OPC�JC��LA.�.%.li' <br />CONTRACTOR � ADORES� CITY2IP PHONE I <br />����� �n�.e�,� rr��p�,���� Sn��P , o,� ;�n��o���� �� £'�Eo_•� <br />CONTR. LICFNSE # <br />USE OF BUILDING <br />�1 <br />l �: � � /� � /.; U .�] L <br />WORK DESCRIPTION <br />J.��S 7�+� __ /� ;t�; (i �� ,�.�/� <br />NO. I NPE OF FIXTURE OR ITEM <br />Toilel <br />BalhWb <br />Lavalory (wash basin) <br />3hower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />HEATSOURCE <br />Eleclrir. _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />i <br />/Jf��aJ J—i2£.�LdG� �[�L$ %/�T <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handhn� units <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas (ireplace <br />Gas range <br />Clolhes dryer <br />Rangehood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Retrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAx CODE IS 3105 <br />I hereby ceritify that I have read and examined lhis application and know the same to be Irue and correct. All provisions of laws and <br />ordinaces governinc� this type of work will be complied wilh whelher specified herein or noL The grenting of a permit does nof presume <br />to give authority lo violate or cancel the provision of any other state or local law regulaling construclion or the periormance of <br />construction. That I am authorized by the owner of lhis propeRy to periorm tho work for which applicalion is made and I wmpty with the <br />Stale Contrac.`.ors Law 18.27 RCW and 296.200 WAC. <br />i�`-/�-v� <br />� <br />