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P r-RMIT APPLICATIUN <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. # PERMIT# <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC� -7 <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> g_ S,QJtZt- Eve�rc.+4 `f 2d ! <br /> TENANT NAME CONTACT FOR PERMIT PHONE 36p. 536 ^1 6Cj z¢ <br /> /V/4 �2 G.2 5 r�-- E-MAIL�errr S+.L173 e ka"flwd:l.Coup <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR. LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric ✓Gas Other - <br /> WORK DESCRIPTION (—cj, <br /> T' <br /> v�e,..J v�o� c�o t'w��i`S . 'Cti�:�-k�r:o r w_1.1 b.e✓ !`��tiod e1 Q..�. T�-2� �o�S�,�Vt�1 c.,S <br /> .`{ W 1�1 C VCL_E�L Ple&i L e-- rJ ec_.z3,20oc� tile—o-^a�.c��w� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> o� Toilet A/C-air handling units <br /> I Bathtub Forced air systems <br /> Lavatory (wash basin) ! Gas piping <br /> Shower ! Water heater <br /> Kitchen sink & disposal ' �/ Gas fireplace <br /> I Dishwasher �( � ✓✓� Gas range <br /> l Clothes washer ! Clothes dryer <br /> l Water heater / �� 1 Range hood <br /> a Sink(service/bar/mop/etc.) }� 3 Exhaust fan Z <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> f Roof drains Other Ummd r'P!=o4c-e- iAs e-'`k <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 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 /> 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 C ntractors Law 18.27 RCW and 296.200 WAC. <br /> -b2.C— a3 -�-oo <br /> Signa ure of Owner/Contractor/Authorized Agent Date <br />