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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 PARCEL TAX I.D. # <br />C'��,-q�r� <br />(`/,rill Ufa �l.ir t-FRAC <br />— LOT NO. BLOCKTOR SUDDIVISIO # <br />DESC. <br />I PERMIT # <br />�I0L-2LEGAL <br />OWNER <br />ADDRESS <br />CITY/ZIP PHONE <br />2— <br />LLt'A"K �Li1LlN I Qdl tit/X�I <br />NC- DR. �,. ,I <br />ll- Slo-�5 <br />.1 r' <br />TENANT NAME -(-c ICiy!-1 fs I <br />I <br />CONTACT FOR PERMIT <br />P ONE <br />ICl�t1NE oo C H D <br />C 5-T I tC�%� �v��.�Fl� f� E-MAIL _ -- <br />CONTRACT) <br />I L1AN- 1«-C C C� �, r �l�-IrlGr rr <br />ADDRESS / P TY/21P PHONE CQ <br />ram. (Z�b�=J �� I L. Iv �`• 2:,( �72 tc"54>(� <br />CONTR. LICENSE # ,7 <br />`,��"-(c� <br />USE OF BUILUING <br />NEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I yT&�t 12-PN I <br />_Electric Gas _ Other <br />_ <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />NO. I <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbarlmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains I <br />Other S!t4c- 'Trun'izc.Cl <br />__ <br />__ <br />__ <br />_ <br />__ <br />__ <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes drier <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />_ <br />_ <br />_ <br />1 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and kno,v the same to be true and correct. All provisions of laws and <br />ordinates 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 stale 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 118.227�7 R''CW and 296.200 WAC. <br />Sig 7Btu ra of Owner/Contractor Au hi Dried Agent Date <br />