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SITE ADDRESS <br />� � � � 1 ��.�,�'�:�� <br />LEGAL LOT NO. <br />DESC. � <br />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 />�� � (�-� �" PARCEL TAX I.D. # PERMIT <br />`��:> i� t�p'� �`� �`-t "��tL`-�\ �.L��'i� � %�� C���S -C.� <br />BLOCK TRACT OR SUBDIVISION # ° <br />1'3. '��} � v i�=�-1. ;" l 4�� j 1J'��1�.�� ;� <br />OWNER ADDRESS GfiYILIP F'HVNt <br />-���- �.�,2�.ti ����v�"'�� . ,�'' , . , � �-tt:� �� 3�__ <br />� i� �� �� �C' t� i`-� 1�''�n�l�:�. L'C � c� l,'� �S ��`� 3v3 I <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />CONTR. LICENSE # <br />�SE OF BUILDING <br />;_.�v,.} ,�� �,---= •�`�� 1��:,�v �\ �1..._, <br />WORK DESCRIPTION <br />t�� `,=3 r ;� <br />E-MAIL`) �� f �K-� �� = <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />� Electri� Gas _ Other <br />C����S���-� t--t �-�.-� ���� L:,r,� �,�s.:,.:�-� v� S► ►I�� < <l-��� �,�- �-� c � �-�� �:.(� � <br />,�,:� <br />� , � ��-�: C \ �_ _� � —k;— � _,` � (�« c:�� � � <�c � <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <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 />NO. <br />MECHANICAL <br />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 />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 appiication 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 Law 18.�7 RCW and 296.200 WAC. , <br />gnature ofi"Owner/Cont�ctor/Authorized Agent <br />