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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 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />LEGAL LOT NO. <br />BLOCK <br />t TRACT <br />DESC. <br />OWNER ADDRESS � p J CITY2IP PHONE[,/�J� <br />/\ <br />l-)Z- � for detl�l -/ 6���i'�+f".r�•t; / � t7 h � JMu%t /7�' � � li �rC•`i:.? <br />TENANT NAM <br />CONTACT FOR PERMIT PHONE <br />S"�^���� <br />y i t,i,1 �ti(t•� �r,2 y.2r � z i1.., �> <br />CON F�CT! ADDRESSPHONE <br />CONTj2. LICENSE <br />Srr ;-I f-USE <br />O BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />-� A <br />I <br />— Electric Gas Other <br />I <br />WORK DESCRIPTION <br />L J) .LLL uyq wa 4-e- ltijou K�� S�Yr' <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 />_ <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />_Gas <br />piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />_Gas <br />range <br />_ <br />Clothes washer <br />_Clothes <br />dryer <br />_ <br />Laundry tray <br />_Range <br />hood <br />_ <br />Sink(service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />BackOow preventer <br />_Heat <br />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 />_ <br />_ <br />Roof drains <br />._ <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cedlity 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 />c0 traction. Thal I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />S e Contractors Lew 18.27 RCW and 296.200 WAC. <br />S' tore of O er ontraclor/Authorized Agent e I / <br />r Z- <br />