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P�MIT APPLICATI�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 <br />;�Sc` � 7 <br />LEGAL LOT NO. <br />DESC. �L � <br />f �� c- �4 �=:�,� � <br />BLOCK <br />PARCEL TAX I.D. # PERMIT # <br />. i� �. C C:� 3 �l 2 � �:�c ( <� z 1 �� �_; �j �L� / - � .� <br />TRACT <br />� <br />,` <br />_S ��r �=! C �`.' �� ' � L L �j �� t�vr �� <br />UWIVtK AUUKtSS GIIY/LIP PHONE <br />_ .�4� <br />. � � -_ / � ` �j <br />L� 1.i � �� '� � I t� � L 1.-1 c' : "( f: r`-'T` � ! � � � > % �7,�' r'�' c�:: �S��t � �-t %L ' ` I' �J ���7 4 � �� l� I �.. .� <br />(_(.� C_._ � <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />de'�4-e '�-.U' i - i1�a � c:� �°l:A ;� ; �_ � � -'1f � Q <br />q�s-� — �-G3 <br />CONTRACTOR �� L� ,� �-�` ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />�� ,�-b t :�;-�. � <br />WORK DESCRIPTION ('C-r�, �7-�� �-� c s <br />/ <br />;.::; C=""i--7-� c If C_: r� r�C � � <br />HEAT SOURCE ._ CONTRACT PRICE OF WORK <br />l`v � � t. ,Y: . <br />_ Electric _ Gas _ Other �7� � � %c_: r' � �, J �%/ <br />, ,, �--,�...i <br />� !� � / :'� ; `� ,,'� � -. �: - <br />PLUMBING <br />�'`✓ a� <br />NO. I TYPE OF FIXTURE OR ITEM r <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 />MECHANICAL A <br />NO. I 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 />Rangehood <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. Ali 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 autho '.to vi I�te or cancel the prov �un of any other state or local law regulating construction or the performance of <br />constructi . Tha� I mtia �thorized by the ner of this property to perform the work for which application is made and I comply with the <br />State C tractorsJ aw 18.2T�W�d 6;200 WAC. <br />G�� �' . -Z � o� <br />Siqnature of Owner/Contractdr/Authorized Aaent / D te <br />