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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 13L� N�d� /l C� PARCEL TAX I.D. # PERM�4� # <br />��c���--t-, w� ��� 3 C"X�3� z� o � ao0 L� 1 �� �5�� - �� <br />LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION #, <br />DESC. � ���� 3 t3e�e�l � I l �D�v <br />OWNER ADDRESS CITY/ZIP PHONE 4L� _ S33 ` <br />�N �� � �. -�U �P�-N 1��� � � �O l� '('� w� l�� 1� �� d�� �� � <br />TENANT NAME I CONTACT FOR PERMIT PHONE 4L,� ��-�31 <br />CONTR. LICENSE # <br />USE OF BUILDING <br />� �J V �'�--� <br />�N av� � <br />HEAT SOURCE <br />� Electri� Gas Other <br />WORK DESCRIPTION <br />G�(�J t/��jl,� � c�. �j� (��� rW"� i ( � '('eS1�l,(��'J � � <br />CJ <br />E-MAIL��� <br />CONTRACT PRICE OF WORK <br />PLUMBING I MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM � NO. � 7�YPE OF FIXTURE OR ITEM <br />T't <br />Batht <br />Lavatory ash basin) <br />Shower <br />Kitchen sink & di osal <br />Dishwasher <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 />)J�%'j �,:��?,;�,_ � <br />, � - <br />� �� ��� <br />� <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 />Exhaustfan <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 authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors I�aw 18.27 RCW and 296.200 WAC. <br />Signature <br />� �� ���n� <br />Date <br />� <br />� <br />