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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. It PERMIT N <br />LEGAI LOT N0. BLOCK TRACT OR SUBDIVISION N <br />DEsc 3p OUD - er '7' Y -7;,-acrr <br />OWNER ADDRESS CITN,ZIP PHONE _ =ayti Ve <br />GLEN VNq ,rc7,E�i7"6s 370 / 6rFc'>%✓c cn �7. 10Vr7'wr <br />s u / it //0 7"x 7 -P7 x/ <br />TENANT NAME TCONTACT FOR PERMIT PHONE .1/,7 S'77y/�S'i OCJ <br />N �',?,7fa..-P.2'�S=cs �'i ei@,IAIL /��•+(3 ©T�cal yuj. Imo^ <br />CONTRACTOn ADDRESS S UYy'ZIlf PHONEC O <br />CONTR. LICENSE N <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />-.yiI �< Electric _ GBs Other .� ?� % O O U <br />WORK DESCRIPTION <br />ON 7>0T!�ON Oi D.Lrci/j <br />PLUMBING MECHANICAL <br />NO. TYPE OF Fi`TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />_ Toilcl _ AIC — air handling units <br />_ Balhlub Forced air systems <br />_ Lavatory (wash basin) -_ Gas piping <br />_ Shower __ Water heater <br />_ Kitchen sink 8 disposal _. Gas fireplace <br />_ Dishwasher .-_ Gas range <br />_ Clothes washer _ _ Clothes dryer <br />_ Water heater __ Range hood <br />_ Sink (servlcelbar/mopletc.) _ Exhaust ran <br />_ Backflow preventer Heat pump <br />_ Urinal __ Unit heater <br />_ Drinking Fountain Boller <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 />1 hereby ceritity 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 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 />Stale Co ctors Law 18.27 RCW and 296.200 WAC. <br />ignature of Owner/ ontractor; Aul ooze gent Da �� <br />