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r'ERMIT ARPLICAI �ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR S fREET, 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 & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />�I�oo S �-{'� <br />LEGA LOT NO. <br />DESC. <br />PARCEL TAX I.D. # PE <br />r� Z90532o(53C�3t5c� , <br />BLOCK TRACT <br />P,�uc�►2, Vavr,� `f(ooa S�,q�e 6vr �187�3 C�)`�s��Z� <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />CONTRACTOR <br />01n1 it1L 1� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />ADORE55 <br />HEATSOURCE <br />L Electric _ Gas _ Oiher <br />INS'1�A �-�- �,}� INE7S � �PpLIfFN c " S <br />NO. I TYPE OF FI%TURE OR ITEM <br />Tuilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />� Kitchen sink 8 disposal <br />� DishwashEr <br />_ Clothes washer <br />_ Laundry tray <br />Sink (;ervice/barlmop/etc.) <br />BackP,ow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Greasetrap <br />Roof drains <br />Other <br />CITY2IP PHONE <br />CONTRACT PRICE OF WORK <br />NO. � TYPE OF FIXTURE OR ITEM <br />NC — air handling units <br />Forced ai� systems <br />Gas pipir5 <br />Water heater <br />Gas fireplace <br />Gas range <br />7lothes dryer <br />� 2ange hood <br />2xhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refngeration <br />_� Waodsrove <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3'105 <br />I hereby ceritify that I have read ar.i examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work wiil be complied wilh �vhether specified herein er noL The granting of a permit does not presume <br />to give authonry ro violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am aulhorized by the owner of this property to perform the work for which application is made and i comply with the <br />State Cantractors Law 18.27 RCW and 29E.200 WAC. <br />J,,... (��— 2.z2 • 05- <br />Signamre ot OwnerlContractonAuthonzed Agent Cate <br />