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i <br />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 & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS , <br />?//� r/2Sf !/pie <br />PARCEL TAX I.D. # <br />D�O�y1�'W <br />P RMIT # <br />L-b(P -�' <br />LEGAL LOT NO. BLOCK TRACT <br />DESC.J ti t.����2,1 V I q I <br />Z� <br />OWNER ADDREP TYIZIP PHONE <br />Ael', �IW,$ z�c �aia�&"t 4m wy ��vei�i`9d�oy h/3�' I�,SG9 <br />TENANT NAME I CONTACT PERMIT PHONE <br />CONTRACTOR ,y"p ,c}S pwtlg�- ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # lq K ^ ; ! 5 f4.�q S S G3 _ <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />` <br />J r IlU0/,�v 1 _ Electric Gas _ Other <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet II Il II <br />A/C — air handling units <br />Bathtub M r <br />Lavatory (wash basin) It Il I <br />'� <br />Forced air systems <br />Gas piping <br />Snower <br />Water heater <br />Kitchen sink & disposal I I <br />Gas fireplace )j <br />Dishwasherl I <br />Gas range <br />Clothes washer j <br />Clothes dyer <br />Laundry tray <br />Range hood I► <br />Sink (service/bar/mop/etc.) <br />Exhaust fan �11 I t I 1 ) <br />_ <br />Backflow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstuve <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify that I have read and examined this application and kn w 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 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 4�trxoctors Law 18.27 RCW and 296.200 WAG. <br />/Lia7 <br />Signature of Owner/Contractor/Authorized Agent <br />