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PE`KMIT 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 mRE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS �{ <br />PARCEL TAX I.D. # <br />PERMIT # <br />l <br />c• / <br />Sr .i5 C� c�G i l� aLI e 3 t <br />00.0 C M <br />O— <br />LEGA. LOT NO. <br />4LOCK <br />TRACT <br />DESC <br />OWNER ADDRESS CITY/ZIP PHONE <br />t, lit (004J L QT o <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Itl' G Qk Plug <br />4rsjT93-7;4s-/a <br />CONTRACTOR ADDRESS CITYIZIP/I PHONE <br />,jQ,jtjtS I0lcfw9/A)6 r �`302 i 4,t tL yNn�tJFt�` ��Z�� 01L6 <br />CONTR. LICENSE # <br />-Tu4sP4- l Z/7W s -is <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric _Gas _Other <br />I/ c� <br />WORK DESCRIPTION <br />2A j�Al� I)r.rd I��op vrT;Is� rGaer._, A�✓D C�'ftS R/,pi�f� SYJ�I�.� �P <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />r- <br />z' «k »-a t ispasol 14A,j(7 51AJKS <br />_ <br />Gas fireplace <br />Dishwasher <br />_ <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Water heater <br />Range hood <br />Sink (service/ba[/ o etc.) <br />Exhaust fan <br />_L <br />Backflow preventer <br />Heat pump <br />_L <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove 1 <br />Roof drains <br />Other 901Z,74 Oyc- <br />Other r/e c r }/)t S <br />_ <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 state or local law regulating construction or the performance of <br />construclio . That n1 a�lthorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Co racto s La 113. 7 RCW and 296.200 WAC. <br />y) <br />Sign ure of Own Contractor/Authorized Agent Date <br />