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PERMIT APPLICATION <br />PERMIT APPLICATION � <br />EVERETT PERMIT <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. IY <br />PERMIT N <br />LEGAL LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION M <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />�lln� <br />TENAN7TpNAME,�y� <br />-a)] <br />C,IIC-Vr(// <br />� <br />CONTACT <br />CO/N_TACT_F/OR PERMIT / PHONE(��l�C)i_��y{{ <br />t Cia uv1o5 Fv� I <br />/ <br />EMAIL rUS{llll%Ir.!/Y)Ul nl%_)Fc) <br />I+aaTRA uSt/ l2lun7� 1/%,/Jy� T11C QYCl7CCJt(/hCt sf Comcpas�- <br />�q � <br />�l`�S��l_,{SCI� <br />u'((m✓rvG roJq.➢ .IlS�dav� <br />CONTR. LICENSE M RuJl7! /� L L/O�/i� Q .J eQ/ / �E r ��.�C� l J ��ill <br />Secry�L.h %h[G <br />er...oxv <br />USE OF BUILDING <br />�me....e <br />HEAT SOURCE <br /><ovA:�...z <br />CONTRACT PRICE OF WORK <br />�F <br />I — Electric _Gas Other <br />WORK DESCRIPTION <br />Lrs/n[t.�J 3 /we,e�lvw�.u✓.enYe.�d <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C —air handling ands <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />_Gas <br />piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 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 />Sink (servicelbarlmop/etc.) <br />Exhaust tan <br />Backgow preventer (�) <br />_Heat <br />pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />_Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodslove <br />Roof drains <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I 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 state or local law regulating construction or the performance of <br />construction. Thal I am authorized by the owner of this properly to perform the work for which application is made and I comply with the <br />Stale,po����ltaclor��s Law 16.27 RCW and 296.200 WAC. <br />(1/l�/-//irr./ '. �'1/1Cc <br />Signature o Owner/Contractor/Authorized Agent Dale <br />