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P�,ZMIT APPLICATIG,J <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 - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 1 l`4l�l- l9�" ��c , S � . � -10 l -�I2,5" <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> S I l.UE4 LAK[ � L A 2. A <br /> TENANT NAME CONTACT FOR?�RMIT PHONE <br /> s�s�+� �,►� � � T� c��z�� zo6 �s� -.��y� <br /> CONTRACTOR ; ���(� t-L.�r:u.�+�o`� ADDRESSZIZ.S� lyb Sh w CITY2IP HONE <br /> v �•�-�I- I�8 wL���j-�?l zc�6 3S�-syy <br /> CONTR.LICENSE# D K� r,� Fz y�y Dq q"`A <br /> USE OF BUILDING I — HEAT SOURCE I CO�TRACT PR�E OF WORK <br /> ��G�;�, ��L-�- Electric Gas Other ,��v��� ` <br /> WORK DESCRIPTION <br /> I r� STALL C�A55 T IC ITGNC� EK�iAJsT l"'100� <br /> PLUMBING MECHANICAL <br /> NO. 1YPE OF FIXTURE OR ITEM NO. TYPE OF FIXNRE OR ITEM <br /> _ Toilet A/C-air handling units <br /> _ Bathtub � Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplac� <br /> Dishw�^�.' Gas range <br /> _ Clothes�. sner Clathes dryer <br /> _ Laundry tray ,�_ Range hood <br /> Sink (servi ,a7mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trep Woodstove <br /> � Roof drains Other <br /> Other — <br /> _I _ — - <br /> CI'�Y OF EYERETT LOCAL SALES SAX CODE IS J105 <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 /> ordinaces governing this rype of work will be complied H�ith whether specified herein or not.The granling of a permit does not presume <br /> to give authority lo 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 of this property to aerform the work for which application is made and I comply with the <br /> State C tractors Law 18.27 RCW and 296.200 WAC. <br /> ���� ��/��/ 07 <br /> Signature of OwneNContractodAuthonzed Agent Date ( <br /> � � ti <br />