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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 ��,(� / 7 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />/ 15 z e- L 19-''/l <br />6103 i3 --, a a <br />LEGAL LOT NO. <br />DESC. <br />BLOCK <br />TRACT ,Q f <br />t/ / 4� 1/ o W,3;7 <br />OWNER ADDRESS CITY/ZIP PHONE <br />roe- / /Z /�. �s�.r� I� i3 n' �C�/ x �� r .y AS cy �jffZ.f2 260 6 9/-7&57 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />( Jve%, ",,-1� Xjlog_ 0 <br />CONTRACTOR ADDRESSCITY/ZIP PHONE <br />CONTR. LICENSE # G� S-2, 5�, <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />SC-5 ' _ <br />_ Electric _ Gas _ Other <br />WORK DESCRIPTION <br />K�Li Ac, <br />p3C� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />j <br />Toilet <br />A/C - air handling units <br />3 <br />Bathtub <br />Forced air systems <br />3 <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />—L <br />Water heater <br />i <br />Kitchen sink & disposal <br />1 <br />Gas fireplace <br />Dishwasher <br />Gas range <br />/ <br />Clothes washer <br />7- <br />Clothes dryer <br />Z <br />Water heater <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <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 authori ed by the owner of this property to perform the work for which application is made and I comply with the <br />State ntractors La 18.2 296.200 WAC. <br />/ure of caner/Contractor/Authorized Agent Date <br />