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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 - wvvw.e.erettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS (0 2'r>/vRcq.1WA'/ PARCEL TAX I.D. # PERMIT # <br />Ek 7Ti 9 9d'Zn �toU % CJiJ C <br />LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION tt <br />DESC. <br />OWNER �fi3iT�JT Fop t�ZO/ %=S') wiGY� drl.TF lJ .FYIZZIP PHONE <br />AA�qJ) ` � <br />/z/rin A✓irY wA iyzo/ �158 Gz�9 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />c-MAIL <br />CONTRACTOR e5 lGe7v ADDRESS CITYI IP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric Gcs Other <br />WORK DESCRIPTION ,(�� /�/o.ci>/nnJ �' ��c ��$'TAIlGi `V7/P&1C77-,Ae `1e J <br />d�Be.s ,q,✓v Fon✓JA�io.JsTi d� ���lardd•f�E�/vEt°ED <br />oTi9FE- <br />I <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water healer <br />_ <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gasrange <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (service/barlmop/etc.) <br />_ <br />Exhaust fan <br />_ <br />_ <br />Backflow prevenler <br />Heal pump <br />Urinal <br />_ <br />_ <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />_ <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify that I have read and examined 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 by the owner of this property to perform the work ror which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />