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1 <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 />SITE ADDRESS PARCEL TAX I.D. # PERMyTi # <br />�302 �'vc,e�e �E S�ZZ o2� oo/ <br />LEGA LOT NO. BLOCK TRACT <br />DESC. / „ �r / /3LK= /4��2 � SO. �97Q,k. f��i�U 7`a FI/E7Q-�— !�E �_ <br />n <br />OWNER ADDRESS CITY/ZIP PHONE <br />/e/C/-� ��i✓on/ SZv �/KE 5��--�-- SE'�r-�zE- u.,� 9�/o�G.5�3G - Z3�, <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />�Fz-� c-f- �►�I voR.� ����7� I �ui.9�e-,o /r-�n� �.t�- �LT= 7G G-�o r� <br />CONTRACTOR �. /� <br />�aSy� <br />CONTR. LICENSE # � <br />S ADDRESS <br />S � �� f� �% ''` �.S <br />���� <br />CiTY/ZIP PHONE <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />,/;�i�— <br />��—�7 �-- _ Eledric �Gas _ Other �'7,%�'�� � <br />WORK DESCRIPTION <br />le�io ri� �i�/�"�eio�L u�LJ' � �E� v Tb /Llftx-� �va � �v2 <br />/1 i� ..1'iiZ6s ���- �-� . 3 G�''�y `� Z � i � �?'•eo �1' � <br />NO. <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 />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 />NO. <br />T,' �x/sr <br />WICAL ?v e <br />TYPE OF FIXTURE OR ITEM <br />AIC - 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 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 Law 18.27 RCW and 296.200 WAC. <br />Signature of Owner/ ontractor/Authorized Agent Date <br />v2 <br />