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( � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.N P€RMr�IT N � <br /> � ��cr.K ' Or.541`iBCC��`Icd %J 'v�— S <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. � �ip 'OZ �, �i4�.J <br /> OWNER ADDRESS CITY2IP PHONE <br /> ���,,t, (�ucet n�o�a `�•��, iec►c� 1� �•�-T ci�37o3 3y�-v37� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADORE55 CITY2IP PHONE <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 5� n` _Eleclric _Gas�Other <br /> WORK DES RIPTION � <br /> ���� �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toile� AIC—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothos washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Uni�heater <br /> Drinking Fountain Boiler <br /> Floordrain ` Refngeralion <br /> Grease lrap _ Woodstove <br /> Roofdrains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> I hereby ceritify lhat I have read and examined Ihis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work�vill be complied with whether specified herein or noL Tho granting of a permit does not presume <br /> to give authority to violale or cancel ihe provision of any other state or local law regulaling construction or ihe pertormance of <br /> conslruction.That I am authorized by�he owner of ihis propehy to perform�he work for which application is made and I comply wilh ihe <br /> State Contractors Law 18.27 RCW and 29G.200 WAC. <br /> � ,e� `7-�--v S" <br /> Siyn ure ol Owner ComractodAulhonzed Agenl Oate <br /> � �� <br />