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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 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />'6022 (:!7R.&wD <br />I ciq <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DEsc. 19 -20 -21 <br />72 Dob <br />Ev E12 dr�l1 } <br />OWNER ADDRESS CITY/ZIP PHONE <br />(Ay {}hC�C�Af21� 2203 I &t3r\ 2-59-- 22d'S <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Nolte <br />I b-ec>V 7 <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />NOT OYi SJEL+ <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric _Gas —Other <br />110/VOCS <br />WORK DESCRIPTION <br />Tt.642 Oowr- J 0"2 <br />CW-4-t-i 5(•iE <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 />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />_ <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 N D <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <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 />Woodslove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify 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 to violate er cancel the provision of any other state or local law regulating construction or the performance of <br />co ructnan. Tha am aulh ized by the owner of this property to perform the work for which application is made and I comply with the <br />Slate Contractors L w 113.27 CW and 290.200 WAC. <br />Signature Pf Owner/font cto Aulh iz d Agent Date <br />