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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 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PEE{R�MI(T)# <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR S 3DIVISION # <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />yUcjCN fn%IY 5taJS -vT_1-j- Iv Loll <br />TENANT NAME" <br />CONTACCT_ FOR PERMIT PHONE C/jj <br />�� <br />ILI�G N(N2��if raj�/� <br />1 �N �L E-MAIL <br />CONTRACTOR ' ADDRESS �� CITY/ZIP PH NE, <br />/�.J�� 1 <br />A-1r,�/a �ia� /Y4r 177� �G�i�l 7 � <br />0�3/� /i /3), <br />CONTR. LICENSE # ✓Ae Lam% <br />LC C%abl �7a <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />C. <I"i-Len) 510% C <br />_ Electric —Gas —other <br />WORK DESCRIPTION <br />�j+l +lf /✓a/fUn Cr�k/' irf cs���12 <br />on *V o, G� .� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <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 healer <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (service/bar/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 />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br />1 hereby ceritify 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 periormance of <br />construction. That I am authoAqd by the owner of this property to perform the work for which application is made and I comply with the <br />Stale Contraclul Law . 8.2 and 296.200 WAC. <br />Signalu of O ner/Contractor/Authorized Agent Dale <br />biz <br />