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FRMIT APPLICATK N <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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT# <br /> (lo O L.JF YTloc ave 00531 t.2D000 Z-700 !J S7� 023 <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> Z cec: D -co otic, ii•, 1-3...—)..2,-AA `�Alk cervelit- <br /> OWNER ADDRESSCITY/ZIP PHONE <br /> 3c ]1C3 `f2S-513-C22y <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ?W( /+A <br /> Thi Lc 2 - mac r. j <br /> CONTRACTOR �r� ADDRESS CITY/ZIP PHONE <br /> 1L;r st 1�Yic:,`y� y sITuc Xvu.. <br /> P.c27gC„, <br /> CONTR. LICENSE# v�%retk C110_13 y 2 5-5i 3 02 Z� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> .3 , off- si4-3 S{v (� c,,,,,Y,��, Yes <br /> C_ AP SSQt.D�L� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory (wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink & disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink (service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> j ordinaces 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 Contrac o s -w 8. ?-'W and 296.200 WAC. <br /> ignature of Own-. ontractoriAuthorized Agent Date <br />