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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 ( L -02 5& C-Vej&C-Tr )fft-PARCEL TAX I.D. # PERMIT# <br />,�.&J �— <br />LEGAL LOTNO. BLOCK TRACTOR SUBDIVISION # <br />DESC. <br />OWNER t�'7-C�� �d�-r �,� -TIZeDDRESS CITY/ZIP PHONE <br />(// <br />5T1P�oo 13ep�, �l y?6d <br />zo411 S; : 13/X44 NG-r�®ez� <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />=53 -zz3 -73 3 -5, <br />c YI�L n� <br />EMAIL <br />CONTRACTOR ADDRESS CITY P N EF <br />�G16 ,P.T <br />CONTR. LICENSE # <br />el�Nyo cG g 33 I36o Lt%LEuba�� 4a/_9�223-733.3 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />— Electric Gas —Other�OD <br />^ <br />I <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C - air handling units <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />_ <br />Water heater <br />1_ <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_L <br />Water heater <br />_ <br />Range hood <br />Sink (servicelbar/mop/etc.) <br />_ <br />Exhaust fan <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />_ <br />Unit healer <br />Drinking Fountain <br />_ <br />Boiler <br />Floor drain <br />Refrigeration <br />L <br />Grease trap <br />_ <br />Woodstove <br />_ <br />Roof drains <br />_ <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 />ordinaces 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 slate or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and 1 comply with the <br />State Contractors Lq27 CW and 96.200 WAC. <br />� <br />t <br />Signature of Q ntW o t/or//AA�uthordzed Agent Date <br />