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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 -gj�Sj C_ ';3 J <br />PARCEL TAX I.D. # <br />PERMIT# <br />f <br />06 13 000 ok oa <br />& jt, <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. 18, <br />1 <br />1 (-c-^-e- <br />OWNER ADDRESS CITY/ZIP PHONE <br />C'r—M&e 1 t- L L-C_ S4 0 36 ( COe. eq ?eti 75 z1, <br />TENANT NAME <br />I CONTACT FOR PER IT PHONE L,(ZS -2 <br />1M, G N.� s t. <br />f ` 1. E-MAIL �Crut <br />(CONTRACTOR ADDRESS CITY/ZIP PHONE <br />IkNc 2c= <br />IJ�W50 G(kDq $/✓G' 'jGG 14VG vw X -303 4 r/27 <br />CONTR. LICENSE # <br />bAL,JS 01, Q <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />0 <br />Electric Gas _ Other <br />WORK DESCRIPTION n <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />3 <br />-X- <br />Toilet I I { <br />A/C— air handling units <br />Bathtub I I <br />�_ <br />Forced air systems 1 <br />1W <br />Lavatory (wash basin) I 1 ; <br />Gas piping <br />Shower <br />�_ <br />Water heater <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_L <br />Clothes washer_ <br />Clothes dryer <br />_ <br />Water heater <br />�_ <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan i, ! e, <br />—L <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 />_L <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify that 1 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 1 am authorized by the owner of this property to perform the work for which application is made and L comply with the <br />State Co tractors Law 18.27 RCW and 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />