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PERMIT APPLICATI(A <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 SAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBiT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TP.X I.D. # <br />PERMIT # <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE y��/_J35� ?yGp <br />J <br />(�/J� A (� p <br />I�C� %� / "y /� � f l d l Z #O` .�Q%c�. <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />&C4�40� &iC'L-%Gr "r Z7r-77S-s!v�l�'�I <br />CONTRACTOR DAr f-tj/Tr I"L InL�L,.,j-H�. ADDRESS CITY2IP PHONE <br />7� —1 77�-G4 <br />CONTR. LICENSE # 'J�'1i1,•�I p/tG7 y4 (' /✓L <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT WORK <br />_ Electric A Gas _Other <br />(PRICE <br />%OF <br />WORK DESCRIPTION <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 />Lavatory (wash basin) <br />� <br />Gas piping <br />Shower <br />Water heater <br />— <br />Kitchen sink &disposal <br />� <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />_Clothes <br />dryar <br />_ <br />Laundry tray <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />_ <br />Unit heater <br />_Urinal <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Roof drains <br />Woodsto_ve ifk L �E <br />Other � .�7tfe iC Puri Pa <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <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 />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 />struction. 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 />,..dte Ars Law 1RCdSignat <br />nContractouAuthonzed gent Date <br />