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PERMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 —FAX 425-257-8857 — www.evereltwa.org <br />S � OJ/ APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. G PERMIjtF <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION !! <br />UESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />a 93 0 !,a e-rf h aye `/,Zs=ems � 8892 <br />TENAN NAME CONTACT FOR PERMIT PHONE L%i2S =%Sy—y%11 <br />/ T�q <br />D� GN l L�7 EMAIL � �/Y%CLI�.•N <br />CONTRACTOR AD—D SS ITYIZIP PHONE <br />CONTR. LICENSEN lJn <br />I� <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />_Electric _Gas _Other 1Fj/�Ur C-2 <br />—WORK <br />DESCRIPTION <br />PLUMBING l <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEh1 <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />.r+/C-air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />_Gas <br />piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink &disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />_Gas <br />range <br />Clothes washer <br />Clothes dryer <br />Water healer <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Dackllow preventer <br />_Heat <br />pump <br />_ <br />Urinal <br />Drinking Fountain <br />_Unit <br />_Boiler <br />healer <br />Floor drain <br />Refrigeration 2 e/(,p -C <br />_ <br />Grease trap <br />Roof drains <br />Woodslove �// <br />5 "' ` J ', <br />Other <br />S (ILA <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have road 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 compl w' whether specified herein or not. The granting of a permit does not presume <br />to give au rity to violate cancel the rov'sio f ther state or local law regulating construction or the performance of <br />const ion That I am Ihoriz by l e n o 1i properly to perform the work for which application is made and I comply with the <br />St Conlr cloys La 18.27 a 96. _0 J <br />oF23 <br />Signature of Owner/Contractor/Authorized Agent Date <br />l <br />