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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 S —0 b <br />SITE ADDRESS <br />,-�,� �6tik4 livA rL�+ Hwy <br />PARCEL TAX I.D. # <br />2aosz�rv�����o <br />ERMIT # <br />P) //� <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CIT0P PHONE <br />E .vCtre}{- "�r;hodl t7isi'. Z x13o 6or verJy G/6 ZI-4 g85-4f 90 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />hl fiver l.okke <br />+Zh 317 - 04 (-1 <br />CON ?TOR ADDRESS CITYZP PHONE <br />W81)C4 WS-- 5jW+5vvvAv1 H407 pouf 13��a <br />CONTR. LICENSE # <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />II <br />dam` ,1A �' GSSv�o��s Y ElecUc Gas Other <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — s:' handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Laundry tray <br />_ <br />Range hood <br />_ <br />Sink (service/bar/niop/etc.) <br />Exhaust fan <br />_ <br />Backfiow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br />1 hereby ceritify that I have read end 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 />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 of this property to perform the work for which application is made and I comply with the <br />State ConUectors Law 18.27 RCW and 296.2D0 WAC. <br />Signature of Owner/ContraLtor/Authorized Agent Date <br />I Z <br />