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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 <br />SITE ADDRESS <br />12�f5 (3ojhel( ;�erei; i�w ! <br />PARCEL TAX I.D. 0 <br />2�0'�2�003o34ou <br />/PERMIT N <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYr23P PHONE <br />t�yereii'' G ool 41-d&6 (by Ave. f�ver++It?,03 47530ti-419`6 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />dvetr l-AL.a I enfclr��cHI <br />-rom C-,I i4(iIn 41-6 - VI - 0017 <br />COIJTRACTOR ADDRESS CITY2IP PHONE <br />Wi Ij�vvt5 <br />N LICENSE / <br />�CO� I��L�. f o'Z i WA. <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />�Sro0VN' I <br />Electric —Gas —Other <br />WORK DESCRIPTION <br />FQuv jc&l on �or relaca�-e�1 porf-able ail ay�rdom <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 />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Krclr.en sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clotnes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backfiow preventer <br />_ <br />Heat pump <br />Urinal <br />_ <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />_ <br />WDodstove <br />Roof drains <br />_ <br />Other_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />1 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 />ordina .as 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 Contractors Jrtw� 18�.27 RCW and 296.200 WAC. <br />I 1 <br />Signature of OWner/ContraCtor/Autnonzed Agent Date <br />I/ <br />/Z <br />