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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICE'S <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.Drg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SIT ADDRESS 1 PARCEL TAX I.D. PERMIT # <br />`J <br />q 3-" 'J`r6 73oc7 <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYMP PHONE <br />%tip S �'� r )YJ� 3 l R6U u� VA, qM q,) a69-zD <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />�AW16 )VD <br />_ <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I <br />_Electric .Gas —Other <br />WORK DESCRIPTION 13 U /Lp N&-t&) 05C <br />I LL 2 ua'j , :° Er ,47W r'i-ICn G_rpzom7 RtiUW <br />Jrr'l\ - \4Cob ' 01 <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />__ <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Water heater <br />Shower <br />Kitchen sink & disposal <br />Gas fireplace <br />I <br />Dishwasher <br />Clothes washer <br />Gas range <br />Clothes dryer <br />_T <br />Laundry tray <br />Range hood <br />Exhaust fan <br />_ <br />Sink (servi;elbarlmop/etc.) <br />Heat pump <br />_ <br />Backflow preventer <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Founldin <br />Floor drain <br />___ <br />Boiler <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />Other_ <br />Roof drains <br />_ <br />Olhar <br />A <br />— -- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 0705 <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 grunting 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 authorized by the owner f this property to perform the work for which application is made and I comply with the <br />State Contractors Law 16.27 RCW�arid 296.200�1AC. <br />Signature of Owner/Contract rlAuthonzed Agent Date <br />Q <br />M <br />DII <br />