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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 />PARCEL TAX I.D. N <br />PERMIT If <br />064 V16T4Pme�E <br />vo 01a <br />LEGAq LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />E<-SETT <br />/ n7 <br />1f}f�1CK �C7� �C�7i ✓?�t) 5� gi-X1W 475355-O7C) <br />TENANTNAME <br />CONTACT FOR PERMIT PHONE <br />BrYA-P.I C"ct-tPP tiz6-1/4'(f <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />D.4Y4dl E Qu/mBIN(r f 1i!Cr /L.(rlN AyIJNua'D q25-7756YGy <br />CONTR. LICENSE M (q os;7 <br />_/ <br />Df}YNSQHOL/�iGrv� <br />USE OF BUILDING <br />_ <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric #Gas — Other <br />5lc✓, uL/ <br />I <br />WORK DESCRIPTION <br />eeGtAc-g iEKt5r1/J6Y &-eCTRIC- Fu,zrvACE uJrTH nJew <br />C LECT-P' I C- %FC-tJ.AC�C • <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 />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backilow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <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 goveming 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 state or local law regulating construction or the performance of <br />construction. That I ant authorized by the owner of this property to perform the work fo, which application is made and I comply with the <br />Slate Cgrrtl'actors Law 18.27 ZW and r2200 WAC. <br />ry', <br />1 ci <br />Signature of caner/Contractor/Au nzed Ageol Date <br />