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F JRMIT APPLICATI- ,V <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 />/ <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM b <br />SITE ADDRESS �/— <br />PARCEL TAX I.D. # <br />PERMIT # J <br />D <br />LEGALLOT NO.f�BLO2-C <br />CK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYlZIP PHONE <br />Jk�'�5;-g- 73q - <br />g z� y �s <br />TENANT'NAME <br />CONTACT FOR PERMIT PHONE <br />E-MAIL <br />CONTRACTOR ESS CiTYtzIP <br />r14,V,gz C-,-V Yfa;vS r✓F.V7-,WC7 7A096tf';!,Jz lyf 3Gb • G SF!'et / z Y <br />CONTR. LICENSE # ,�1� fv Z `L <br />,// 1 7 fy, 17D <br />USE OF BUILDING HEAT SOURCE C TRACT PRICE OF WORK <br />N�a _ Electric Gas _ Other <br />WORK DESCRIPTION � <br />( 4 <br />C -�'1 C l .� G 'Jl <br />C�1Cl OlK�j l v�ot cUw� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />= <br />Gas piping <br />Water heater <br />Shower <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />-loVater heater <br />Range hood <br />Sink (servicelbar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Floordrain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodstove <br />_ <br />_ <br />Roof drains <br />_ <br />Other— <br />Other — <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application 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 give authority to violate or can 1 the provision of any other stale or local law regulating construction or the performance of <br />conslructio .That I am authon d by a owner of this property to perform the work for which application is made and I comply with the <br />w l8.27 C 200 WAC. <br />State C raclors awl <br />Signature of wner Conlracto Aut razed Agent Dale <br />