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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.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ,,07 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />0043011 7G21Qo <br />��ti-oa5 <br />LEGA LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION N <br />DESC. (� <br />44 <br />� o <br />OWNER ADDRESS CITY2IP H <br />'Po k CWAOAr Pa4`twft 240�a UtJOt+mIle AX)B,AC*, WA _ <br />TENANT NAME CO TACT FOR PE MIT � PHONE w` .`uu .;I <br />{/1 1_ c <br />V <br />CONTR. LICENSE N <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />✓Electric _Gas _Other <br />WORK DESCRIPTION �M1 � <br />`� [o�y�y <br />v <br />�'lV�il''�/�iIG'r�'�r�•� T�v� 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 />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />_Gas <br />piping <br />Shower <br />Water heater <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothe- dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />Sink (service/bar/mopretc.) <br />Exhaust fan <br />_ <br />Backflow prevenler <br />Heat pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />_ <br />Root drains <br />_Other__ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritily 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 stale or local law regulating conslruUi�n or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which appl.„alion is made and I comply with the <br />State Co r aw 14.27 RCW nd 296.200 WAC. <br />r <br />Si fur nenCon ra on uthorize Agent Date <br />v <br />