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env I <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-881.0 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM is -ate. <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />l� o� 5� cuc�ctt /cul �� <br />a8o�l10o 4 o`i IDC) <br />LEGAL LOT NO. <br />BLOCK TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYIP PHONE <br />M I ,�^ ./,Z//� <br />o-u `JF F-'1tf 't 1. 1GL(� t �iCGtl/2�oLoa <br />TENANT NAME FOR PERMIT / PHONE�1 STi �l 5 U <br />nCONTACT <br />1 <br />LV `1�( I Wnn,C `t�L<.- E-MAILVjj^^ J -k�LJa <br />s <br />CONTRACTOR L)(000 C 13`l E %J(r'PHUCITYIZIPN11?J' �l1 3U <br />CONTR. LcCEN9E #F�$ <br />\iuL(1DPS 3-)\ Wb <br />USE OF BUILDING HEAT SOURCE ONTRACT PRICE OF WORK <br />`/ n Electric Gas Other ,� V <br />X � I <br />i IlliL �ktXiH1 <br />WORKD SCRIPTION epllooC trKtS+,' 340+1 <br />d� <br />PLUMBING <br />MECHR NICAL <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 />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />_ <br />Water healer <br />_ <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas rauge <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />_ <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />_ <br />Unit heater <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Floor drain <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 7105 <br />1 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 cancel the provision of any other state or local law regulating construction or the performance of <br />construction. Th t I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Sta C tre r Law 1 .27 RCW1and 296,200 WAC. <br />Signature o Owner/Contractor/Authonzed Agem Date <br />"K <br />