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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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX ;.D. # <br />PERMIT # <br />'15D1 FAARDESo1J ?,oan !a o4te a7z eog oo <br />L -/% <br />LEGAL LOT NO. BLOCK <br />TRACT <br />OESC. --6Q(1�1,71 <br />� IIER ACDRESS CITY/ZIP PHONE <br />frTuL 5fll SouTHQr/AL i21,oge%nine ° ",2239-AjW--sV.51.K';L <br />TENANT NAME <br />%?e54/er PJtrG47T/ <br />CONTACT FOR PERMIT PHONE <br />fr9/7fx� '1�6 - 325-Z553 <br />CONTRACTOR I ADDRESS CITY/ZIP PHONE <br />% � a <br />CONTR. LICENSE # i' /,L�� — -) 10Ui <br />' dam" J <br />USE OF BUILDING 1 <br />HEAT SOURCE <br />C NTRACT PRICE OF WORK <br />/,/, A P,C4C�U,2/!X' <br />Electric v Gas _ Other <br />d 9C?'�� QOO <br />WORK DESCRIPTION <br />/,cJ7'E32/c✓L �r/LE �IJ H�}�JCJF < �vOX-7A G /•�J�7�2oYG77F�Lr�S wcuiv�uC <br />yl 4w2c <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 />_ <br />Lavatory (wash ! 3sin) <br />Gas piping <br />Shower <br />Water healer <br />t <br />Kitchen sink & disposal <br />\, — <br />Gas (replace <br />Dishwasher_ <br />Gas range TJ <br />Clothes washer <br />Clothes dryer I` 1) <br />— <br />— <br />_ <br />Laundry tray <br />Sink (service/bar/map/etc.) <br />Range hood ly <br />Exhaust fan <br />_ <br />Backfiow prevenler <br />Heat pump <br />—L_ <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />T <br />Floor drain <br />Refrigeration <br />— <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other_- <br />Other <br />CITY OF EVERETT L OOAL SALES TAX CODE IS 3105 <br />1 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 />ordinares 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. That I am authorized by the owner of this property to perform the work for which application is rr.ade and I comply with the <br />S e ntrac Law 18.27 RCW and 296.200 WAC. <br />r <br />Signature of Owner/Contractor/Au orizea Agent Date r <br />Z <br />