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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 />-7-a6-0 7 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # <br />PERMIT # <br />LEGA LOT NO. eLOCK�TRACT OR SUBDIVISIO ! # <br />S <br />DEC. <br />OWNER ADDRESS CITY/ZIP PHONE,���� <br />.5f'/Lf %✓T- ��X E L ?4e*ie / 054e5 .2� r✓E lee,>W,0 411e I 1'Q-_ -%-W-T <br />ST6- /tSD t//f ¢2S 2:2 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE,//� <br />lsJ�J.ellt�l%-'✓Sit'✓ <br />E-MAIL <br />CONTRACTOR ADDRESS CITY/ZIP ONE G <br />45� /o Z �; 1GTfi 'l v!t/ <br />CONTF. LICENSE"B� 'B'A' <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />�N/Mcu�/e9TTa+S j�'✓E/� <br />s. <br />— Electric _ Gas _ � OtherAlb' <br />y�/11j 0"- 0 <br />— <br />WORK DESCRIPTION <br />/��YLIi a�ESEL �+•tZG'S/E/.'+�fTd/� ��- B�9Ci�-z/� ��,r+E/LC�1�''✓G �/ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />-_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Waterhedter <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Water healer <br />_ <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <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 3105 <br />1 hereby cerilify 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 pres..me <br />to give authority o violate or cancel the provision of any other stale or local law regulating construction or the performance of <br />construction, at by the owner of this property to perform the work for which application is made and I comply with the <br />kautho;c'ed <br />State Contr L and 296.200 WAC. <br />/D <br />Signatu e Owner/Contractor/Authorized Agent Lyate l / <br />2 <br />