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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. # <br />PERMIT # <br />i W - =-r <br />1 <br />1 Yn i (TV r7 <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # _ <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />'TmJl_5 f�0�'S Cr1o4ur.t.--Ells & 2o,c c? &rr' �'t W6 (y)3>9--�f/y5 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Y <br />w K^I(�If-1 <br />AIL) <br />E-MAIL <br />CON�C`T R ADDRESS)) �' iTY0P PHONE <br />CV�IZ 2�eni S�vt �l�ltr E �C LI ZJ Y9c�t c L =lirZC f <br />CONTR. LICENSE # <br />�L161W5S02067- �42sj z5z- 3/ly <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric —Gas —Other I ,�j 47) C, (� <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE. OR ITEM <br />NO. TYPE OF FIXTURE OH ITEM <br />'reilet <br />__ <br />AM, — air handling units <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />Kitchen sink 8 disposal <br />Dishwasher <br />_ <br />__ <br />Gas fireplace <br />Gas range <br />— <br />Clothes washer <br />Clothes dryer <br />Water healer <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow prevonter <br />_L <br />Heat pump <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Unit heater <br />Boiler <br />Refrigeration <br />_._ <br />Grease trap <br />Woodstove <br />..___ <br />Gins <br />Roof drains <br />Other <br />Other <br />Other <br />----- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby coritify 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 state or local law regulating construction or the performance of <br />construction. That I am aut o{ized by the owner of this property to perform the work for which application is made and I comply with the <br />State C n actors La 2 CW and 296.200 WAC. <br />SS-S=lo <br />Signal re of wno , ntractor/Authorized Agent Date <br />