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SITE ADDRESS <br />LOT NO. <br />TENANT NAME <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 <br />PARCEL TAX I.D. # <br />� <br />BLOCK TRACT OR SUBDIVISION # <br />puma D/y. <br />AD�-D EDSS <br />�.z Fx- sr <br />IGC�c,, 202 EaMc <br />I CONTACT FOR PERMIT <br />Gfil=-Z- <br />PERMIT # <br />' ,I 0I'201_0_ <br />PHONE Z061 -1 <br />MI ,4,;:`O /R CC/tiR./D(y EGVA/S, <br />E-MAIL GaM <br />CONTRACTOR ADU!KtJJ <br />'3Lur^ <br />CONTR. LICENSE # Zoe • g/9• �4a •3 <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />S�=/2 Electric _Gas Other <br />WORK DESCRIPTION <br />l "6-7-y?G!%U) <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />_ <br />— <br />_ <br />! <br />Forced air systems <br />Gas piping <br />Water healer <br />`ti <br />Shower <br />Kitchen sink & disposal <br />! <br />Gas fireplace <br />! <br />Dishwasher <br />! <br />( <br />Gas range <br />Clothes dryer <br />/ <br />Clothes washer <br />�- <br />Range hood <br />Z%- <br />Water healer <br />Sink (service/bar/mop/efc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />(o <br />Exhaust fan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />_ <br />_ <br />_ <br />_ <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />__ <br />Woodslove <br />Other <br />_--- <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions or laws and <br />ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other slate or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contr�Nv 18.27 RCW�290.200 WAC. <br />�/ /o • <br />Date <br />