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PIRMIT APPLICAT16A <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 I.D. # PERMIT # <br />5�73 a2- <br />7-5-01 hq desc,v /rr> _ d2 2 04-7- —004-6c)00 <br />LEGALI LOT NO. BLOCK TRACT <br />DESC. <br />�— <br />OWNER ADDRESS r.ITYIZIP PHONE <br />1 6-i v4 i S y// S. Q uar L, re, d. a c,a eCL S ,444n4- L�A <br />_V <br />TENANT NAME <br />CONTA T FOR PERMIT PHONE <br />M e-55iGr- <br />Sievc Plot 4 I/LS-77L`f83.S- <br />CONTRACTOR ADDRESS CITY0P PHONE _ <br />N ec ti eg0 -z <br />%1O l7$- <br />/y .724- <br />%YoC /i#rliSo.v <br />CONTR. LICENSE# gt_ A(u7%c A, <br />USE OF BUILDING <br />HEAT SOURCE <br />PRICE OF WORK <br />r :vw)�- <br />_ Electric _ Gas _ Other <br />ddCONTRACT <br />WORK DESCRIPTION -2i�4ft Ajjr: 5 <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 />_ <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 />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <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 />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify 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 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 am a horized b caner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law .27 200 WAC. <br />Signalur of OwnerrContractonAuthorized Agent Date �/� <br />