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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 />APPLICATIONS ARE <br />ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. p <br />PERMIT X <br />3Y,E7 &KeTAc <br />6vtm--77 <br />BGLIb7-U24r <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER <br />ADDRESS CITYZP PHONE <br />/7 C V I V /-I'yV rc-(.rL14 <br />cle 41S .3;>��nus Ariz Fvc-yt77-7-9&20/ 0),Isr--3esh <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />C Je A/s <br />(IL14 Utz)-Wi-6(1$12 <br />CONTRACTOR <br />ADDRESS CITY21P PHONE <br />CONTR. LICENSE k <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />/2E5 / oc q << <br />I <br />_Electric X Gas —Other <br />WORK DESCRIPTION <br />ADD <br />A S/nOcE BRnfRC�Vt /� �It� 695E17E-I`T-. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C - air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />_ <br />Range hood <br />_ <br />Sink (servicelbar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit healer <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <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 INS 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 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 />Slate Contractors Lbw 18.27 RCWja}d 296.200 WAC. <br />'Jignature of Owner/Contractor/Authorized Agent ate <br />(U - yz <br />