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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.evereftwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />0IfC EVef rc-e,,j cvc, 02a'OSo`7po2cf ' do <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />OrW,N/ER ADDRESS CITYIZIP PHONE <br />' fa <br />i�.2 <br />�-C .SA f✓ w <br />TENANT NAME, CONTACT FOR PERMtT PHONE <br />Hide k I <br />o� �i� ►M�Hn✓� -'-12!;- $-22 /Z�,� <br />CONTRACTOR ADDRESS CITYIZIP PHONE Z1.2S <br />co��E5E''uyC�o 8-2 -2/2a <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />�L• �i f / �US 7 ss _ Electric _ Gas _ Other Z7// Q U61 <br />WORK DESCRIPTION Ii�'1dUe G'LCLi/ i2oLectp �Cis-� L,, &"cC -5 <br />Q1.?, <br />c1KC' .�N57�t c[ OAf ' Not-IY-t E�fi. <br />_^, 5 �4 e L CJ .New it,4y " -- �; O X-" �crs ALL t <br />' <br />e <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />Bathtub <br />_ <br />A/C— air handling units <br />Lavatory (wash basin) <br />_ <br />Forced air systems <br />Gas piping <br />_ <br />Shower <br />Kitchen sink 8 disposal <br />_ <br />_ <br />Water heater <br />Gas fireplace <br />Dishwasher <br />_ <br />Gas range <br />Clothes washer <br />_ <br />Clothes dryer <br />Laundry tray <br />_ <br />Range hood <br />Sink (serflow <br />_ <br />Exhaust fan <br />reventmop/etc.) <br />Backllow prevenler <br />_ <br />Heat pump <br />Urinal <br />_ <br />Unit healer <br />Drinking Fountain <br />_ <br />Boiler <br />Floor drain <br />_ <br />_ <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />_ <br />Other <br />Other <br />— <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 />con coon. 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 />Stye ontractors L w 8 27 RCW and 296.200 WAC. f ` <br />O� <br />/ <br />OJ <br />re of Owne /Contractor/Author ed Agent Date �/Z <br />