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PERMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 —FAX 425-257-8857 — www.everettwa.olg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS � <br />PARCEL TAX I.D. # <br />`/-// <br />PERMIT# <br />12 i1'1� Laic, I <br />O0 0 l 5' r)/ , <br />LEGAL LOT NO. <br />BLOC C <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />I `)V M c /1 , / -'.,c ES,-H 9 JS'lr <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />A�j <br />4• v �1 o n <br />S)'Ic V C � �n 3J� % S o) sy <br />CON ACTOR ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE N <br />a,y C r q C L P y <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />G_Electric <br />_Gas Other <br />WORK DESCRIPTION e yr' S%i3 <br />o r.rcc+4eA,� <br />PLUMBING <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />NO. I TYPE OF FIXTURE OR ITEM <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 healer <br />_ <br />Kitchen sink &disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodsfove <br />_ <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify 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 cr cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the )vner of this property to perform the work for which application is made and I comply with the <br />WAG. <br />Stal Co raclors Law 18.2 CW a 29G200 <br />5igrfature of Owner/ConlracJ uthorized Agent Dale <br />�L <br />