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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 <br />/v Zy �vsC <br />D �� <br />PARCEL TAX I.D. # <br />S3Cdoocsa/9ol <br />PERMIT # <br />( ;1 OI O <br />LEGAL LOT NO. <br />DESC. S <br />BLOCK <br />TRACT OR SUBDIVISION # <br />QLIr/la ;Z4*4/4 e IV <br />OWNER <br />ADD E55 CITYIZIP PHONE Z06•i�I'�S <br />Sr <br />FAQ E/FST G M:�YL�P�s6lLC <br />z -aFx- <br />�c t �oY Eallol/DS <br />%�20 <br />TENANT NAWr. <br />CONTACT FOR PERMIT <br />PHONE L �6 ' Sl4 • �Q•/ 3 <br />c.ci�R-/DC�EC.an/S <br />E-MAIL COM <br />Gfll--Z— T'J <br />rirwiiP PHONE <br />CONTRACTOR nuuncaa -•Cl• / - - - <br />rjC.uE /NL '�0 73oye362 %�uvtfel g / p q 7 <br />CONTR, LICENSE# T.�vlo' b✓ /'7� <br />USE O� BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric _Gas _Other <br />WORK DESCRIPTION S'�C 4-64 4 <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 />Bathtub <br />Lavatory (wash basin) <br />= <br />Forced air systems <br />Gas piping <br />?L <br />—3 <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />! <br />I <br />/ <br />I <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Clothes washer <br />T <br />Range hood <br />Water healer <br />6 <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Backllow preventer <br />Urinal <br />Drinking Fountain <br />_ <br />__ <br />Heat pump <br />Unit heater <br />Boiler <br />R frigeration <br />_ <br />_ <br />_ <br />_ <br />Floor drain <br />Woodstove <br />Grease trap <br />_ <br />Other <br />Roof drains <br />Other <br />— <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinances 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 stale 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 .ipplication is made and I comply with the <br />State Contrac�to�s- w 18.27 RCW/429G.200 WAC <br />Date t/� <br />