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PCRMIT APPLICATI(N <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 /0 --3 _Q7 <br />SITE ADDRESS <br />PARCEL TAX I.D. 0 <br />PERMIT N <br />5 0 ',, -#I Ia t-d e so R <br />Z Q2 41-29/X� <br />1.2 'IQ9 --3o <br />LEGAL LOT NO. <br />DESC.r <br />BLOCK <br />TRACT OR SUBDIVISION E <br />OWNER ADDRESS awaiP PHONE <br />�(avie C"PIT�EE��'yCl� P�-�hEl e hate h. <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE 4 ZSS-CONTRACTOR <br />Pat -LC P)cnelavenKc EMAIL U�.80�QiCgCu® <br />CITYIZIP <br />CONIR. LICENSEE <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />ll A <br />Electric _ Other <br />1 U f <br />_4Gas <br />t/J_ <br />WORK DESCRIPTION Ct&ttoPIxu <br />e ►v� cC'�� E �. i �� S 'G»'I <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 />_ <br />_ <br />Lavatory (wash ba^in) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink(service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow prevenler <br />_ <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 ceritify 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 stale or local law requlating 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 made and I comply with the <br />Slate Contractors Law 18.27 RCW and 296.200 WAC. <br />OT I4.0-7. <br />Signature of Offer/C00nnttraaclor/Au razed Agent Date <br />f(i <br />Y.. <br />