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PERMIT APPLICATIUN <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 />/O —A-1 i$ <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT • <br />7 & / o 67 1„ /- aR LVerat. kirj <br />I e 03 9.3 JO11)2-0 <br />LEGA LOTHO. <br />BLOCK <br />TRACTORSUBDIVINMIr <br />DESC. <br />OWNER ADDRESS CRY/LP PHONE <br />Lou;,, N7- Lal-so,--I iy &t35X8 �VLrl7Y.WA 9y2./3 425-353-/3yA' <br />TENANTHAME <br />CONTACT FOR PERMIT PHONE a12S--3S3-13f? <br />x'Yte, <br />I /&r'6 Larsorl <br />EMAIL <br />CONTRACTORC'ADDREa'I Hsu• t;�l�„�. � i v iB ,-c.,dw«.../-• EVsi',!rl'.:t/,4 jYiO( 25Y-G L L ¢ <br />CONTR. DCENSE f eAj ! 1�1 c %j Z 'y d 5 5-1i <br />USE OF BUILDING <br />MEAT SOURCE <br />CONTRACT PRICE OF WORK <br />�\ 3 , r%n lc eJ I <br />— Electric /Gas _ Other <br />`� O ¢ 4 S. a o <br />I <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ _ <br />AIC - air handling units <br />Bathtub <br />Forced air systems 9 <br />Lavatory (wash basin) <br />.�-_ <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />_/ <br />( <br />Gas fireplace I <br />Dishwasher <br />Gas range <br />Clothes washer <br />__ <br />_ _ _ <br />Clothes dryer <br />Water heater <br />_ <br />Range hood <br />Sink (service/bar/mop/etc.) <br />___ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />Urinal <br />_ <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />__ <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />_ <br />Woodstove <br />Roof drains <br />._ <br />Other ____ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 31D5 <br />I hereby ceritify, that 1 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 />construction. Tpat I am authorized by the owner of this property to perform the work for which application is made and 1 comply with the <br />StatsGontrqiiffbrs Law 18.2777296. WAC. <br />Signature of Owner/Contractor/Autho ed Agent Date <br />