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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 />063�23951002G� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />ANA ever "d. <br />PARCEL TAX I.D. # I PFRMIT# <br />- 2-32- <br />LEGAL LOT NO. <br />DESC. 2 <br />BLOCK <br />S <br />TRACT ,I p �+ r_ / <br />J4f k- VD M 0. Cq J noluimrtfl <br />OWNER ADDRESS CITYIZIP PHONE <br />µzs 3Ss z9fSo <br />n QQ Q '` <br />�Obert R• RO�IAC R. Pierre - g�l� DRVerQy I&J. Everett 144 19203 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />ONTRACTORr' ADDRESS CITYIZIP. PHONE,,, <br />CONTR. LICENSE q *r <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />n <br />S i n9G! f ayol e, homy R — I <br />✓Electric _ Gas ✓Other SOLAR <br />A r�Jj <br />WORK DESCRIPTION p— on Lot <br />I _/ aty ar Everelt STpQAC. A AP. g606160i2o <br />�I3 ? <br />NEW Nousb <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />( <br />Toilet <br />A/C - air handling units <br />I <br />Bathtub 'I <br />Forced air systems <br />Lavatory (wash basin) l// <br />Shower <br />Gas piping <br />Water heater I <br />// <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Clothes washer <br />Z <br />Gas range <br />Clothes dryer <br />Water healer <br />Sink (service/bar/mop/etc.) 1 <br />Range hood i <br />rxhaust ran IV <br />Backflow preventer <br />1._ <br />Heal pump <br />Urinal <br />Unit healer <br />_ <br />Drinking Fountain <br />Boller <br />_ <br />Floor drain <br />__ <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />_ <br />Roof drains <br />Other _ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby coritify that I have read and a amined this application and know the same to be true and correct. All provisions of laws and <br />ordinates 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 Ly the owner of this property to perform the work for which application is made and I comply with the <br />Stale Contracto s aw 1d RCW and 2y6.20n WAC. <br />Signature of OwnertuonNactorlAuthorized Agent Date <br />V'i <br />G- <br />