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P�MIT APPLICATIC�I <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 8� CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS "� PARCEL TAX I.D. # PERMIT # <br />:� � � 3 � — `S {- - I x` �,, � _i_ �� � � <br />LEGAL� LOT NO. BLOCK I TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />�� � �--t� ►'1 � c.� , ���✓ C v�-� � 2�=cc; �'ti �ct-�����5� - S F- S �-�-'�"�"��` ��'� � ���-' -� - C�z� <br />TENANT NAME CONTACT FOR PERMIT � PHONE <br />� I w� �� ��.�( i��-,-�,�� � 1, �� �.( I <br />� <br />CONTRACTOR 1 -�� ADDRESS f CITY/ZIP PHONE y <br />C� T� �:lh,V���JI � �� zCr��� �.�a ��� 2 2 Z /��ti p <br />I � I l. 1FiY'�or-� F-�,� . in_L�.'E �`� �it�; -CL(r /-`7S (o `O <br />CONTR. LICENSE # �'�I1'4" �r�ytG+^ � �-�� y'�'�� 5 <br />G�T�ry �iv�rg���'�Y�� � <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. <br />�_ <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 />HEAT SOURCE <br />Electric Gas Other <br />M <br />CONTRACT PRICE OF WORK <br />ANICAL <br />NO. I TYPE OF FIXTURE OR fTEM <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 />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 Contra tors L��7 RCW and 296.200 WAC. <br />� �-- � � - �5' <br />