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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 `` <br />PARCEL TAX I.D. # <br />PERMIT # <br />— <br />3S i ,'f y'S tt MAII wl{ Y <br />o S C <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />0 i3 Wtt) rN l jL) o, � � C3 W D, Ilk y T )c -1 ra `10 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />,u, A -rArb112e, <br />S'cc bl -k�n,A3WAN SU9Co3(-, ?7Pr6 <br />CONTRACTOR fIJLY, N ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE R <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />_ Electric 1�, Gas _ Other <br />/V7 (vo <br />ir,{ill li" rlti:S l Vio�d w�fxM s1 1310v4n n�eAi)OC-D,.t VnA^ Tr)�.(1 <br />�ORKDESCRIPTION <br />) $�v,,.s� 'FArsi {..+//1'+SCC. Aw F.•.n..�lc `1 ..J�11 �� �,rµ. kk av n. n. w�Nss(,Y.e..�T wtQ�� 'i 1..,�(1 <br />/ <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 />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />Sink (service/bar/mop/etc.) <br />3 <br />Exhaust fan <br />_ <br />BackBow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />Roof drains <br />I <br />Other» N � H r <br />_ <br />Otter <br />J— <br />hr.1 µW'A V fR1a �{ QI. a <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 a hority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construcli n. That I am truthorized by the owner of this properly to perform the work for which application is made and I comply with the <br />State C tractor 18.27 RCW and 296.200 WAC. <br />� <br />Signalure of Owner ont uthorized Agent Date <br />2 <br />