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{ <br />PLRMIT 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 />PARCEL TAX I.D. # <br />5 nre <br />ZZO <br />LEGAL LOT NO. BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY2IP PHONE <br />lk.leza <br />L%/J/7i ��I Lan��eyS /% 00 ����,�- .vc all y25- Y22-0727 <br />TENANT AME / I CONTACT FOR PERMIT PHONE <br />' <br />i 7 C/ <br />CONTRACTOR _ / ADDRESS CITY/zIP PHONE <br />/ <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I — Electric Gas Other <br />WORKDESCRIPTION �R Tre-L✓own3 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C - air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (service/b, r/mop/etc.) <br />Exhaust fan <br />_ <br />BackBow prevenler <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />Drinking FOLnlain <br />Boiler <br />_ <br />Floor drain - <br />Refrigeration <br />Grease trap ''' ))) <br />Woodstove <br />_^ <br />Roof drains 4 <br />Other !'J� <br />Other <br />CITY OFF EVERETT LOCAL SALES TAX CODE IS 310S <br />I hereby ceritify that I h&ve read and examined this application and know the same to be true and ccrrect. All provisions of laws and <br />ordinates governing this C/pe 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 wc; k for which application is made and I comply with the <br />State Contra rs Law 18. C "nd 296.200 WAC. <br />b� O 7-X/el'O.r <br />Sign of Owner/ C ntP for/Au orized Agent Dab; <br />Z <br />