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APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa • rg <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />P RMIT # <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />WLtnn--MXne+ 'jwmpscr. U401 pr;csr �1aryyzvi//e <br />r'o i Mt'DP, I.i 4.1 q V.271 <br />_ <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR Nc50C`6��(`C nl N4fti q- SS' CITY/7_iV PHONE <br />CONTR. LICENSE ftN O q, 5 H <br />USE OF BUILDIN'GI <br />� HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />1 'P S <br />Electric _Gas _Other <br />WORK DESCRIPTION <br />L�7Ci/`-Jj <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 units <br />Forced air systems <br />_Bathtub <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />y <br />Water heater <br />_ <br />Kitchen sink &disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />Sink (service/badmop/etc.) <br />Exhaust fan <br />_ <br />Dackflow prevenler <br />Heat pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby cerilify that I have read and examined this application and know the same to be true and correct. All previsions of laws and <br />ordinaces 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 slate 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 application is made and I comr <br />PERMIT <br />L <br />i <br />