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r <br />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 />50 - 33' <br />PARCEL TAX I.D. # PERMIT # <br />i'7130 I 111 G71!-Ctl�l <br />LEGAq LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />S No2E Ac2E 5 <br />OWNER ADDRESS CITYRIP PHONE <br />WILL)AtA 0T9ZIEI1 S03-7-33n.d AVE W. EVen.JyZS-345 n <br />TENANTNAME <br />I CONTACT FOR PERMIT PHONE <br />'jam yL5-766-47 <br />✓AN E-MAIL <br />CON ?ACTOR C 015 PRONE <br />{ CADDRESS <br />o M` o W N <br />CONTR. LICENSE # 1� <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />h} o u Si5 1116 FArArl <br />Electric _ Gas Other <br />WORK DESCRIPTION <br />G 'NS 1-/NE FP-oA& METr`/L To GAS 2ANSE . <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />__ <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />— <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />1. X <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />Backllow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit healer <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />—_ <br />Grease trap <br />Woodstove <br />Roof drains <br />Other _ <br />_ <br />Other <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritity that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work Will be complied with whether specified herein or not. The granting of a permit does not presume <br />a.givo-a only to violate or ca ceI the provision of any other state or local law regulating construction or die performance of <br />construct on. at I am by the owner of this property to pedorm the work for which application is made and I comply with the <br />. Sl to Contraclo Law .27 W and,296.200 WAC. <br />Signature er/ ntra or/Authorized Agan[ Date <br />