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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 />�D(� s� E �(f Mc� <br />LEGAL LOTNO. BLOCK <br />DESC. <br />JWNER <br />'OU�IE�S L�• I00� <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />'li DVl S-�'�'2�'i�'. <br />TENANT NAME CONTACT FOR PERMIT <br />E�'��'� Co �--� � I'r0 rJ � K- � N C-� <br />PHONE t�03 •23s •CLA�-3 <br />E.Mn�� �4-k�-4-av� � l=i hq <br />sv ���r�rJ 237s �3o-r� p���r� E'xl lvue-,� <br />coNstX�AGvV I D� N-( �. ?AO lF'� " �� c� (�p(,�j `� 25- 7,gA--A�ODD <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />WORKDESCRIPTION }�Unl jVc�'(�'iW <br />PLUMBING _ �� <br />NC TYPE OF FIXTURE OR ITEM <br />foilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/barlmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Roof drains <br />Other <br />_ Electric _ Gas __ Other I I�j, Q�� <br />�h w�l �s� �1Lw 1�D11 w� <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />Forced air systems <br />Gas piping � <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigerelion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />d�� <br />I hereby certify that I have read and examined this application and know lhe same to be true and cortect. All provisions of �aws and <br />ordinances governing ihis type of work will be complied with whether specifed herein or not. The granting o( a permit does not presume <br />to 9ive aulhority to violate or cancel lhe provision of any olher sfate or local law regulating construclion or lhe performance of <br />constniciion. That I am authorized by the o�aner of this property to perform the work for which application is made and I comply with the <br />Stat Contractors Law 1827 RCW an .�u.200 WAC. <br />�.'�S'� ii� <br />Signatore o wn ContrectoqAuthonzed Agent Date <br />�IL <br />