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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257 3810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEFTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />7t_� <br />3 7Gyl aC'W <br />LEGAL LOT NU. BLOCK TRACT <br />DESC. 5&F ATT ' ftC_ <br />OWNER ADDRESS CITY/ZIP PHONE <br />L�L.AItLZ (ZOCV "6451 (S u.0 g)/ 1)te,,,g<ej o% PJ NjO>Y3 51 MA%19g4&F r,U-4 ` 110 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />�AtSlti'AL— <br />IkIW +LiV T �7lf�c St}tlur�,L' / 5"'771u-`ss�S <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />-Et.—p U_-DiJ 5/G �U ec '7q&o /�r}I2aE5r /21� CZ't)2L� turf 9J� -776 `sr 3�_ <br />CONTR. LICENSE # <br />t3r721�f',UPU77r//4 ��►'' 7-/'1-Oi <br />USE OF BUILDING <br />HEAT SOURCE <br />CT <br />ONTRAPRICE OF WORK <br />I <br />— Electric Gas Other <br />/ IleI/I c 2 <br />) <br />WORK DESCRIPTION Rc)m6o .W ECI,UX1-377k)lf� Af'LlT��7C�C� i��rr>LL <br />uZ �(ft'Ce� 1170N —LI 7- 5//r/1/S <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />_ <br />Water healer <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water healer <br />_ <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />ExhaL ;l fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />_ <br />Unit healer <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />Woodslove <br />_ <br />Roof drains <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I 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 stale or local law regulating construction or the performance of <br />conslrucli ' at 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 Co tract rs Law 18.27 WamJ 96.200 WAC. <br />iv a <br />SIgMaTure of Owner/Contractor/Authorized Agent Date <br />��ti <br />