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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVE.RETT, WA 98201 <br />425-257-8810 — FAX 425-257-8837 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PAPCEL TAX I.D. # <br />PERMT # <br />2,2)33 /- & - - <br />LEGALL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />—�/ <br />OWNER nn ADDRESS CITY/zIP PHONE (`7 <br />TENANT NAME FOR PERMIT PHONE �y/�5n'_/ <br />//� <br />//� <br />l(CONTACT <br />N i� E-MAI � hl �C J•' 7L�k�! / <br />CONTRACT6R2v,,/��% ySl' N `hr zol �,c%�u�il�J45;n-� <br />T � <br />CONTR. LICEN�SSEE# <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />�, iy /� %l •i4 ', A) Electric —Gas _ Other <br />I <br />WORK ESCRIPTION <br />J ' <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />X <br />Toilet <br />A/C — air handling units <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Shower <br />Gas piping <br />Water heater <br />Kitchen sink & disposal <br />Dishwasher <br />_ <br />Gas fireplace <br />Gas range <br />Clothes washer <br />1 <br />Clothes dryer <br />Water heater <br />1 <br />Range hood <br />Sink (service/barhnop/etc.) <br />Exhaust fan V <br />_ <br />_ <br />BackBow prevenler <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />Grease trap <br />_ <br />Woodstove <br />_ <br />Roof drains <br />_ <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 />ordinances 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. Thai I am authorized by the owner of this property to perform the w rk for which application is made and I comply with the <br />State Co tractofs 4w 18.27 R and 296.200 WAC. <br />Signature wrier/Contractor/Authorized Agent D e <br />Qf <br />1/z <br />I <br />Iris <br />