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PERMIT APPLICATION <br /> C17Y OF EVERET� PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> AFPLICl:TIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# I PERMIT# <br /> �(I S 0.r� , �'�L �l �1 l7- C7�-�J <br /> LEGAL LOT N0. BLOCK 1 TRACT OR SUBDIVISION# <br /> DESC. I <br /> OVYNER ADDRESS CINIZIP PH7NE <br /> � �� S �ilav�d A-UE �✓e% I-F i?f��3 <br /> TENANT NAME CO�TACT FOR PERMIT PHONE <br /> 4a�-��"}. i��c� <br /> S�S�P.� 1��1u �U�- �Q�ZL�I\� E-MAIL <br /> T F2 � AD-bh� --� �IZI�PA�A�— <br /> '�C,�rz:cCr. �'(C�',�.�{-in�� �ILf� Cve�jrec.. t•�h+� ��- Elk-let4 C($��i <br /> CONTR. LICENSE# � <br /> ��S- �� �- Ik'u� <br /> USE OF BUILDING HEAT SOURCE CO�TRACT PRICE OF WORK <br /> 5�� _[leciric�Gas_Other 3S '�a a� <br /> \ <br /> WORK DESCRIPT�ON <br /> �- I��Ie�U a �% S�/o 2��,e�c,e��,.o�ur►� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling uni�s <br /> _ Bathlub � Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes�vasher Cblhes dryer <br /> Water liealer Range hood <br /> Sink (service/barlmop/elc.l _ Exhausl fan <br /> Backllow preventer _ Hea�pump <br /> Urinal Unit heater <br /> Drinkinc� Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodstove <br /> Roof drains Other <br /> Other _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby cerlify Ihat I have read and examined this appiication and know the same lo be true and correct. AII provisions of laws and <br /> ordinances governing lhis type of work will be complied wilh whether specified herein or nol.The granting of a permit does not presume <br /> to give aulhorily to violate or cancel Ihe provision of any other slale or local law regulaling consiruction or lhe peAormance of <br /> conslruction.That I am authorized by the owner of this property lo perform the work for which application is made and I comply wilh the <br /> State oniractor Law 18.27 RCW and 296.200 WAC. <br /> ` f �'jJT�--�� �U`� �U <br /> Sig�O vi dConlraclor/Aulhonzed Agent Dale <br />