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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 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />//62. S.E. E✓&9877 mAv—WAY <br />PARCEL TAX I.D. # <br />PERMIT # <br />�0 -- �� <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY2IP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />ymlzo� T7. <br />I <br />CONTRACTOR ADDRESS CITY/ZIPPrrONE <br />/17ERrT rhEGHAN�CgLr 111C. 9660•1594VA✓E.A/C. Sf25• �r83 •°12i�i <br />i <br />CONTR LICENSE# Il9E7Q/7'MI Ir:3 Crh CEVE4CM /758(?) <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />— Electric Gas Other <br />I <br />WORK DESCRIPTION <br />pi¢o✓rDE ¢ rNsfRc.�— PcuirllgrAJ6� fi.CT✓,Q,ES <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />I <br />Toilet <br />A/C - airhandlingunits <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />I <br />Water heater <br />_ <br />I rlchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range Food <br />Sink (servicerbar/mop/etc.) <br />_ <br />Exhaust tan <br />_ <br />Backflowpreventer <br />_ <br />Heat pump <br />Urinal <br />Unit heater <br />1 <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Wocdstove <br />_ <br />Roof drains <br />Other <br />Other <br />I <br />CITY OF EVERETT LOCAL SALES TAX CC9E IS 3105 <br />1 hereby ceritify that I have read and examined this application and know the same to `re true and correct. All provisions of laws and <br />ordinaces governing this type of work will be compliad 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 regulatinj construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for vn,ich application is made and I comply with the <br />Stale Contractors-w18.27nd296.200WAC. <br />�• n`-D� <br />Signature of Owner/Contractor/Authorized Agent DateJ <br />