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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 - DEBIT & CREDIT CARDS .ARE NOT ACCEPTED <br />SITE <br />APPRESS <br />PARCEL TAX I.D. • <br />PERMITS <br />ICJ r�� C. L•�eli'T1�Q�1' <br />-�� <br />l <br />LE <br />Aq LOT NO. <br />BLOCK <br />TRACT <br />DE <br />C. <br />OWNER <br />ADDRESS CITYIZIP PHONE <br />_{I r r�6 555 /l �� I-e -" 11163 /` Gy 07-1 <br />TE <br />ANTNAME <br />�U I Cl <br />TACT FOR PERMIT PHONE <br />071s h1(" 0077vc <br />h-\gr1 <br />'?/0 (906,6300 <br />CO <br />ITRACTOR ADDRESS CITYIZIP PHONE <br />C01 <br />ITR. LICENSE 0 <br />UE <br />E OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric Gas _Other <br />51106 <br />WC <br />RK DESCRIPTION <br />Cron�me,"C�IGfk %4-t2-0orTE1Y),1l <br />PLUMBING <br />MECHANICAL <br />NO <br />TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />_ _ <br />A/C — air handling units <br />Bathtub <br />Lavatory (wash basin) <br />Forced air systems <br />Gas piping <br />_ Shower <br />Water beater <br />_ Kitchen sink 8 disposal <br />Gas fireplace <br />_ Dishwasher <br />Gas range <br />_ Clothes washer <br />Clothes dryer <br />Laundry tray <br />Range hood <br />_ Sink (service/bar/mopletc.) <br />Exhaust fan <br />Backftow, preventer <br />_ Urinal <br />Heat pump <br />Unit heater <br />Drinking Fountain <br />_ Floor drain <br />_ <br />Boiler <br />Refrigeration <br />Grease trap <br />Roof drains <br />Other <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 h <br />eby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ord <br />iaces governing this type of work will be complied with whether specked herein or not. The granting of a permit does not presume <br />to c <br />ve authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />cor <br />struction. That I am authorized by the owner of this property to perform the work fa which application is made and I comply with the <br />Sta <br />a ontractors La 1D.27 R Wand 296.200 WAC. <br />Zt XZ a aa� <br />Si <br />oturr. Y wnerlContractor/Au ed Agent Date 1/ <br />