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F cRMIT APPLICATIvN <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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS p <br />10 2- <br />PARCEL TAX I.D. # <br />PEWIT # J <br />T- <br />06o 50U <br />LEGAL LOT NO. <br />DESC. ��`— <br />BLOCK <br />TRACT <br />N 4jc-- DU:r_ <br />OWNER ADDRESS CITYIZIP PHONE •� S 8 c�0 7 <br />I <br />e U .4 CGt/'o l -e_ vtAA-Soa/ ID 20 %V , U2 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />I ( 142s S70 6Nlz <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />N v�SLyct� ,ems o� . . 13o gaX 11& g8Zo( <br />. <br />CONTR. LICENSE # <br />V4 N S L.,r+z d Z1 D o 2\�5� S7� 6%Vl <br />USE OF BUILDING <br />HEAT SOUR..'E <br />CONTRACT PRICE OF WORK <br />Electric _jGas —Other <br />WORK DESCRIPTION // _ <br />3, c k <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 />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <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 slate or local law regulating construction or the performance of <br />construction. That latR authorized y the owner of this property to perform the work for which application is made and I comply with the <br />Slate Cont�t6rsCaw 18. and 296. WAC. <br />Signature of Owner onlract Authorized Agent Date <br />1I <br />