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L`r =? �,,2l- PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES ?o� <br />320C 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 • DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS I <br />PARCEL TAX I.D. # <br />PL RMIT # <br />LEGAL LOT N0. <br />DE <br />C. <br />BLOCK <br />TR{ 999C��T <br />OWNER ADDRESS CITY/ZIP PHONE <br />1 cG <br />T« IVA i�'7t ? 7 �71_I' <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR '� �� ADDRESS CITYrZIP PHONE <br />!r <br />CONTR. LICENSE # <br />(C r'7C'iLi:? <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric V Gas Other <br />WORK DESCRIPTION <br />/ / <br />/L/ 6<� 7, l ,�e4 Ie <br />/.�ZG76 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />—G" <br />A/C —air handling units <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />L <br />Water heater <br />/ <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />Range hood <br />l <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow preventer <br />_(L <br />Heat pump <br />Urinal <br />tzY <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />r <br />Woodstove <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 gave 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 authorized the ow er of this property to perform the work for which application is made and I comply with the <br />Slate Contract 7 R and .200 WAC. <br />gnat re of wner/Contractor Authorized Agent Date \' <br />2 <br />0M <br />