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P�RMIT APpLICA�'I��� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98�01 <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 />C`5/�v C <br />LEGA LOT NO. <br />DESC. <br />I,�IuE C_.Hr <br />TENANTNAME <br />BLOCK <br />PARCEL TAX I.D. # <br />TRACT <br />�7S 3/'-v fluc(� <br />I CONTACT FOR PERMIT <br />�••••�1h13 <br />CONTRACTOR ADORE55 CITY2IP PHONE <br />Evt���e�v 5i�'r� Hc�r ��/G Z�zo Pgc� {c� �r.T �ts�vi (y/ Z�Z-3i<5' <br />CONTR. LICENSE # . <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />3B c�, `° <br />�'�'���/`������ � _ ElecMc Gas _ Other �� <br />WORK DESC IPTION F� T (g� ��='1� {�:COFT� U�V 11� 4JITtt P-��LL ���4LT � <br />/� �(� /.i- <br />�L.��,S P"1 n�''� 1 Tt'W`(J L�J'KT�tJtS� <br />�.f l_ <br />NO. I TYPF t)F FIX'i URE OR ITEM <br />Toilet <br />Bathtuo <br />Lavatory (wash basin) <br />Sho!ver <br />Ki!chen sink & disposal <br />Dishwasher <br />Gc:he� �vasher <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other _ <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Ga� piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />8ailer <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES 7'AX CODE IS 3105 <br />I hereby ceriti(y ihat I havs read and examined lhis application and kno�v the same to be true and correct. All provisions of laws and <br />ordinaces governing this rype of work will be complied with whether specified herein or not. The granting of a p=rmit does noi presume <br />to give authority to violale or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am author d by the owner of this property ,o perform the work for which application is made and I comply with the <br />State Con ra ors Law t. RCW and 296.200 WAC. <br />Signature of OwneriContractodAuthonzed Agent 1 at � //2 <br />