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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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PER IT ,�`� <br />� � is (� �� �l� . �J L' � G � ti,�, i � '_ f j B� 1 — �i 1 ✓ <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />�S �v�t�l I--�' L�,�, �1� �f ��e S��- , ����k ; ��i �- � <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />'�! �-j ►� c�C ��� �� J-S -T S. '� �' ( G' v'� � �=i+ —74• 3-1 7�Ci <br />C9,N� ACT ��. � ADDRESS CITY/ZIP PHONE <br />�,�e� r, �'-� w►' ,}ti � h G/1 .7.Z�. S ICFii1-�l �n J.I-- <br />S�c'a�i�; �=����r �'����_7� r -1���� <br />CONTR. LICENSE # � 1� 1'/� / <br />�V "'� U � L �l �'7 �'" � ( ��i���� <br />USE OF BUILDING <br />WORK DESCRIPTION �� S fi�'� `�,� % L� <br />'�� �`l��"�' �F�4�1 � �Ji1�a � �S �'( �'�h� <br />PLUMBING <br />NO. 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 />Laundry tray <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 />HEAT S�RCE <br />_ Electric _ Gas _ Other <br />7 nx� ' �,�. <br />{ti� � Lt ) r�, � -f=c �r-- <br />CONTRACT PRICE OF WORK <br />���.��� � <br />i C��'�ll�S ��i v��' 1 <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <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 g verning this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give aut rity to violate or cancel the provision of any other state or local law regulating construction or the perFormance of <br />constructi hat I a authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Co c rs L�18.27 RCW and 296.200 WAC. <br />� <br />r/Autho <br />Agent <br />51 r� c� <br />Date <br />�l <br />