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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDARS IREE T, 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 />SITE ADDRESS f PARCEL TAX I.D. p PERMIT 8 <br />9 - I u -oS <br />LEGAL LOT NO. BLOCK TRACT <br />DESC <br />OWNER ADDRESS CITY/ZIP PHONE <br />/d-, 41752zo 9'54'3 <br />6(e / ?,9 Sr^ S/=- e vae&;'1 <br />TENANT NAME <br />I CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADORF,SS CITYIZIP PHONE <br />,,,i" 4,�/ 4f c re o <br />CONTR. LICENSE <br />&/f-.f z1 r— /S <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I <br />— Elcclr.c _ Gas Other <br />3 S? s <br />I <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO, TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />_ <br />Laundry tray <br />_ <br />Range hood <br />Sink (service/bar/moplefc) <br />_ <br />Exhaust fan <br />_ <br />Backgow prevenler <br />J_ <br />Heal pump <br />_ <br />Unnal <br />_ <br />Unit healer <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodslove <br />_ <br />_ <br />Roof drains <br />_ <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br />I hereby cerility Thal I have read and examined this application and know the same to be true and correct All provisions of laws and <br />ordrnaces 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 state 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 Contractors Law Wand 296 200 WAC. <br />D� <br />ignature )!ne ntractor/ uthonzed Agent aft fe, <br />/¢S e R t h %0 7 <br />