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PEMIT APPLICATIO'i,4 <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wvvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT 0 <br />s`i �� Ca/ <br />7V� 3( �I Z <br />LEGA LOT NO. <br />BLOCK TRACT <br />DESC. <br />OWNER ADDRESS CITY/zIP PHONE <br />k 6'rrp"'--t (y z4- )Z <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br /><�j � r✓,-/. (Gfo /L/ i3�4Q�� c✓ ��Z s 7TS'—G�!(v'1 <br />CON. LICENSE # <br />LyR'n[.-;v� <br />J%'/TYiC!/ /'�/c�vYCt1 r✓A <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric Gas Other <br />I <br />WORK DESCRIPTION <br />SE/V1c� <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 />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/b,,r/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow pre%enter <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />�— <br />Other Lj.-,J,-. <.vv,, c <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cedtify 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 for which application is made and I comply with the <br />State Contras rs Law 18.27 ROW and 296.200 WAC. <br />Sig ture of er/Co actor/ uthorized Agent Date <br />