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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 ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.A� PERMIT# <br /> IIIS I' w-,' i�..i �2� ' %� � (��� - OC� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE '�'7 <br /> Rc,�.,,,-, � � tl,� 1113 �' �..,-�.Y l/,�.,.., Dr �v�.� �0-2-3 � <br /> T�NTNAME CONTACTFORPERMIT PHONE <br /> E-MAIL <br /> RA T R ADDRE � �Z�P <br /> CONTR.LICENSE# ��(I�/�� <br /> ' `Cl �� <br /> USE OF BUILDING I HEAT URCE EONTRACT PRICE OF WORK <br /> C�C/V �� <br /> 1 �� Electric _Gas__Other � ` <br /> Si ��1w ��M'I�II I'�Tt,'4')^L — i <br /> WORI�DESCRIPTIO <br /> RIf I <br /> �X'��, 1 v�� c'>I,�l �+^'1�Y1%�!_�L wl`�� h- � tn�/14�'Cs�. � <br /> PLUMBING MECHANiCAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling unils <br /> Balhlub —� Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower __ Water heater <br /> Kilchen sink R disposal _ Gas lireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clothes dryer <br /> Waler heator _ Range hood <br /> Sink(scrvicc/bar/mop/elc.) _ Exhausl(an <br /> Back(low preventer _ Heal pump <br /> Urinal _ Unit heater <br /> Drinkinc� Fountain _ Boiler <br /> Floordrain _ Refrigeratior <br /> Grease trap _ Woodstove <br /> Roo(drains _ OU�er <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y that I have read and examined this appiication and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces c�overning lhis type oi work will be complied wilh whether speci(ied herein or not.The granling o(a permit does nol presume <br /> to give aulhority to violale or cancel lho provision of any other state or local law regulalinc�construction or tho periormance of <br /> conslruction.That I api authorized by the owner o(lhis property lo perform lhe�vork for which application is made and I comply wilh the <br /> State Contractors Law 18.27 RCW an 296200 WAC. � <br /> � l _.- _ - / 7� I /O`1 <br /> Sigrtalur .wnedContracl �orize enl Date <br />