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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 />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D.0 PERMIT# <br />M <br />LEGAL LOT NO. <br />BLOCK TRACT OR SUBDIVISION N <br />DESC. <br />OWNER <br />ADDRESS CITYIZIP PHONE ZoV�t� <br />1&e it <br />-1--" ke 64113 Seeli "OW12A (� <br />TENANT NAMI <br />CONTACT FOR PERMIT PHONE w A`.,7XONS3d <br />1' I E-MAILAM0 <br />�UNTRAGWOR <br />� yLAD 5 13�'1N` R-t a I YI IoY b Zs� aaltiRe <br />CONTR. LICENSE N <br />USE OF BUILDING <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />!Electric Gas Other <br />I <br />AAi <br />_ _ <br />WOR SCRIPTION 1\ <br />1 V (,1LS$Ot:lrs.�C� ft <br />� <br />i 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 />Bathtub <br />Forced air systems <br />--__ <br />Lavatory (w h basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />Kitchen sink & SpeSal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />Water healer <br />^_ _ <br />Range hood <br />Sink (service/bad op/ <br />.) <br />Exhaust fan <br />_ <br />Backllow prev er <br />Heat pump <br />Unnal <br />__ <br />Unit healer <br />_ <br />_ <br />Drinking unlain <br />Boiler <br />Floor in <br />Refrigeration <br />- <br />Gre etrap <br />R Idrains <br />_ _ <br />Woodstove �1 A� _L-__LL <br />Other-._Q� GC ALd+VQk <br />Other <br />-- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined this applicalon and know the same to be true and correct. All provisions of laws and <br />ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to a authority to violate or r<oncn the provision of any other state or local law regulating construction or the performance of <br />c nst rruon. i I am a Ihonz <br />b the owner of this property li Ile me the work for which application is made and I comply with the <br />S ate a La 1 S 27 R <br />Wad 296.200 WAC. <br />� � fY 1 �� <br />Sgn nor/Contmrhr <br />uthonzed Agent <br />M, <br />