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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 />FROM 8 AM TO 4 PM <br />APPLICATIONS ARE ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. 0 <br />PERMIT/ <br />D/ - D()S <br />W5 <br />j�-' �' <br />HCWJLsov <br />LEGAO LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION N <br />DESC. <br />OWNER ADDRESS CITYIZIP PHON IIzs- <br />�r'+ktl CI1 7505 fiardcSoy EV6rA c18201 343 - 6315 <br />rrf j\ <br />TENANT NAME <br />CONTACT FOR PERMIT PH E <br />7 <br />Y�i <br />E4iAIL <br />T)NTRALurNS IT re Sj4e"I.NG Pt7 COR X Llh?h''e F4 f,91'Za <br />CONTR. LICENSE N 11 I 0 <br />�UP.N� F S oz woj (4ZS) 348- C ItK <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />66 k <br />_ Electric _ Gas _ Other <br />WORK DESCRIPTION t4 4veid'V �, U c A4. 4" tAk Aru"&k A70~ bCt till ^I&- U"".t 1�'&C4 <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 basin) <br />Gas piping <br />Shower <br />Water healer <br />_ <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />_ <br />Water healer <br />Range hood <br />_ <br />Sink(serviceibar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <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 7105 <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 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 made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date �/L <br />