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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, VA 98201 <br />425-257-8810 —FAX 425-257-II857 — www.everettwi.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 Pf.1 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PEZMIT # <br />1 I <br />I,o h b Ave <br />00 1- Q 1_ - 0 <br />>-� &' O 's-- <br />I.EGAI LU f N0. <br />DESC. <br />BLOCK <br />TRACT ' \✓t14 <br />1—u <br />PLAT ����r <br />ADDRESS CITY21P PHONE <br />OWNER D <br />CIS V�'rJ 1NQ Simi 3�� I Z l.t7wh (�� t-) RyL- l-Vf32bT IGI i3zDI <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />_UUiI\C��j�_Electric <br />�l• <br />_Gas _,Other <br />WORK DESCRIPTION <br />%21 `FbDt l�,L�PcCt1Z4 C,itWA'UE-, <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />N0. TYPE OF FIXTURE OR ITEM <br />Toilet <br />AiC —air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />_Clothes <br />dryer <br />_ <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />_Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />_ <br />Roof drains <br />_Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 />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 />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State nt ctore Law,t 7 RCW a'nd 2�96.200 WAC. <br />Infractor/Authonz� <br />Signature of Owner ea Agent Date <br />1�2 <br />