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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 />SITE ADDRESS <br />PARCEL TAX I.D. # <br />Rf#1l I <br />3201 k'un'�E�z <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS I CIT9Y�2IP °HONE <br />�2►1�� �'�'8z'7% fcc� <br />%9ri7r/ IZE�cNch+-; lPcc. ,ova/zi,o�E <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />:3L.C` `I 3 5-%`i b� <br />L6o ,'�IRfflsAcr_ <br />GfZ4/f— CUJS <br />CONTRACTOR P1(JN/e1A'f— ADDRESS z786c( p CITY2IP PHONE <br />1�o� 1r70 <br />..7Ht"►i>a.l <br />CONTR. LICENSE # 1 A <br />l•.J <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />7,I <br />_Electric _Gas _Other <br />T?�� <br />WORK DESCRIPTION <br />U2vUr`� V�oc�4— Faf I 4�a.{Llroo++� t 51✓VKS f 1-�oT 5�f1S <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE Or- FIXTURE OR ITEM <br />I <br />Toilet <br />A/C —air handling units <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />� <br />Shower <br />Water heater <br />Kitchen sink &disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Dack(low preventer <br />Heal pump <br />_ <br />Urinal <br />Unit healer <br />_ <br />Drinking Fountain <br />Boiler <br />� <br />Floor drain <br />_Refrigeration <br />Grease trap <br />Woodslove <br />_ <br />Roof drains <br />Other <br />� <br />Other FcnT <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this typo of work will be complied with whether specified herein or not. The granting of a permit does not p•9alr'te <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 Lin authorized by the owner of this property to perform the wxk for which application is made and I comply with tho <br />Stale Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of OwnerlConlractor/Authodzed Agent Date <br />