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PERMIT APPLICATION <br />CITY Or EVERETT PERMIT SERVICES <br />3203 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AIN TO 4 PM 1-4—D';7 <br />SITE ADDRESS <br />Li0 9 Lo1ik4-ea/ At,,e. Ev2ret� <br />PARCEL TAX I.D. # PERMIT # <br />1 0 eL( J 1 00 y 0 a C771 a-CO3 <br />LEGALI LOT NO. <br />DEsc. y s Nloft.(o <br />BLOCK <br />RID <br />TRACT OR SUBDIVISION # <br />�0ere �;v.P. <br />OWNER ADDRESS CITY/ZIP PHONE <br />T �( / <br />fi"J[ZJ:{✓ r�W7¢hlSi'f�"P�'urq& `/a,,Oe✓I(IL, Cal',4-11 3,pLj-2- `f21-Y70-U3 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE �7U�Jf 3 Z <br />f3✓40 07eL4k1< EMAIL U✓ 7.e4A 4/49,Kf-11 <br />rl <br />CONTRACTOR ADDRESSCITY/zIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric Gas Other <br />WORK DESCRIPTION <br />'f` <br />'ex <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 piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodslove <br />Roof drains <br />Other <br />Other <br />=I <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify 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 ;onstruction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and 1 comply with the <br />$tatty !`.p nrinrs I_aw IR 27 RM and 29R 700 WAr' <br />uu <br />Signature of Owner/Contractor/Authorized Agent Date <br />