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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 LZ2 <br />ARCEL TAX I.D. # PERMIT # <br />3 9, -- ar» D� - 06 <br />LEGAL LOT NO. BLOCK <br />DESC. <br />OWNER ADDRESS C /ZIP PHONE <br />���e d� �% CGr �.✓'/ems /.��f T,� G z / sip y tiG �r�� c- L/c st �,� s 9 a2- <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />fret L L/ = yz z- 7 <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />sue? <br />WORK DESCRIPTION <br />PLUM <br />G <br />NO. I TYPE OF FIXTURE OR ITEM <br />3 <br />Toilet <br />Bathtub <br />-3 <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />/ <br />Dishwasher <br />1_ <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />A Electric _ Gas _ Other <br />/vU, D67o <br />lJ 7 Z - 127 jC o <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />._ <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <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 />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 orized by t e owner of this property to perform the work for which application is made and I comply with the <br />State Contractors LooeTIB.27 IOW ay,.200 WAC. <br />nature oT uwne <br />