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CITY OF EVERETT PERMIT SERVICES -�y _v7 <br />3200 CEDAR STREET, EVERETT, WA 98201 �7 ` <br />425-257-8810 — FAX 425-257-8857 — v✓ww.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � 707_ eV/ <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMI7 # <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />CoQCe�(Tzr� �lu za <br />TE'Iy1\ANT NAME �— <br />CONTACT FOR PERMIT PHONE <br />lyt�`(�Q A✓)f ll �kS • <br />E-MAIL <br />CO�RAADjjRESS CITY/ZIP PHONE <br />f�aPtu1Kt3rkWC,LZZ AND,zXoNeN Oft; lir+µTUwe koQ 36o-41foeS3 <br />CONTR. ENS/t' <br />rtJPLtw <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric Gas Other <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C —air handling units <br />Bathtub <br />air systems <br />Lavatory (wash basin) <br />_Forced <br />Gas piping <br />_ <br />Shower <br />Water healer <br />_ <br />Kitchen sink &disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backtlow preventer <br />Heat pump <br />Urinal <br />Unit healer <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />Roo(drains <br />Other <br />i <br />other FuNlv7r. �RpIN <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 performance of <br />am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />constructionZA-- <br />Slate ContraaIV 18.27 RCW and 296.200 WAC. <br />Signature q wJc •r/Contractor/Authorized Agent Date <br />r <br />PERMIT APPLICATION <br />