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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 _ ��� _ O C9 <br />SITE ADDRESS I PARCEL TAX I.D. # <br />2iiz t oy-t �q� <br />PERMIT # <br />coy <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />No�IT Av(�- Eye17-L1-T vjA <br />TENANT NAME <br />I CONTACT FOR PERMIT PHONE <br />EMAIL <br />CONTRACTOR A I�L vc-' y ., V r I�i P ADDRESS I2 P PHO <br />' L Li F-� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />C_ Electric Gas _ Other <br />e, 0L7 a (7 o <br />I <br />WORK DESCRIPTION <br />�G1vl� VV I- i1J P PVfhDI 1, VE'5,A64b 11-004-, LL EXISjtulDM2-\NA`i <br />�\Uvv>,p�t��a q p.,��i,Nt�tlLl!1l� v-1D12j[_ <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 />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Water heater <br />I <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <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 speci'ied herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other slate 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 />Slate Contractors Law 18.27 RCW and 296.200 WAC. <br />— /zgLD el - <br />Signature of Ownor/Contractor/Authorized Agent Date <br />