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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 4?_5-25?-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D./ PERMIT K <br /> 'IG2 Melv, .. AV� � � Ou5 y`� 7 Gf4o1 ,2oZ ^ ,�j'%a -(� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. ' a �-I�j � � ()2 �_(�T O�_�� �C �vrS t' <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��ZS-B70 - 7�Y) <br /> S��„� ��;t� c��,+�4�+��s �. � �X aov3 ���+� 9ez�3 <br /> TENANT NAME CONTACI'FOR PERMIT PNONE <br /> CONTRACTOR ADDRESS CITV2IP PHONE <br /> Sc�c.,�clurc�.., c�.t{aca�-rs �� avx aG�l3 L��� �/2S �7ri- 72y > <br /> CON LICENSEN 5'��3 <br /> �o����oc� S51 �� <br /> USE OF BUILDING ( HEAT SOURCE �ONTRACT PRICE OF WORK <br /> 5 I- 1` _Electric �Gas_Other �3 U� �U CJ <br /> WORK DESCRIPTION <br /> /�d <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> � Bathtub Forced air syslems <br /> Lavatory(wash basin) � Gas piping <br /> Shower i Water heater <br /> �_ Kilchen sink&disposal � Gas Tireplace <br /> �_ Dishwasher � Gas range <br /> �_ Clothes washer � Clothes dryor <br /> J_ Waler healer � Range hood <br /> Sink(service/bar/mop/etc.) '� Exhausl ian <br /> Backflow prevenler Heat pump <br /> � Urinal Unil healer <br /> Drinking Founlain Boiler <br /> Floor dioin Reirigeration <br /> Grease trap Woodslove <br /> Rauf drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify that I have read and examined this application and know the same lo be lrue and correcL All provisions o(laws and <br /> ordinaces goveming this type of work will be complied with whelher specified herein or noL The granling of a pertnil does nol presume <br /> to give authority to violale or el the provision of any other stale or local law regulating construclion or the peAormance of <br /> construction.Tha ffi ed by the owner of this property to periorm the work for which application is made and I comply with the <br /> State Contr rs 8. 7 RCW and 29G.200 WAC. <br /> � �"' � _ J? � 2 � �vs <br /> SignaWre of wnedContraclodAuthonzed Agenl Date `1Y <br />