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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 t / <br />�2� �lflY <br />LAGS r -a Ln O-D <br />LEGA LOT NO. <br />BLOCK TRACT J7 <br />— <br />DESC. <br />— 7 <br />OWNER ADDRESS CITY/ZIP PHONE <br />%% <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />//� 1/PS /32QJ <br />E <br />CONTRACTOR 1Y11S �/-)f%i�CALl- � 1/ „21f �/ir�r�fJJ�uCITY¢IP PHONE y�s_3S9-i3z <br />/ � <br />/7 �=�ryl/9kk�' <br />CONTR. LICENSE# /0 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />kA I L7 <br />Electric A Gas —Other <br />WORK DESCRIPTION �'JI <br />n�t.fWEi � <br />e Lle� 'Ivb71L v4q 41V; L e7L <br />a o� <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 />Z <br />Forced air systems <br />j-�- <br />Lavatory (wash basin) <br />Gas piping <br />Water heater <br />Shower <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />,,1_ <br />Exhaust fan /// <br />_ <br />Backfew prevenler <br />__ <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 />Woodslove <br />_ <br />_ <br />Roof drains <br />Other_ <br />_ <br />—I <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 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 comply with the <br />State Con rat rs Law 18.27 C and 796.200 WAC. <br />k � r.;Z — <br />Signa ure of Owner ontractor/Authorized Agent Date I� <br />