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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 />PARCEL TAX I.D. # <br />PERMIT# <br />1071W►5r�� W. <br />oUS o2-Uw-ooS-oor� <br />(yv/ - <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />el,41 or N CL2FiT EC• V�L.�3 P6•�2 <br />OWNER ADDRESS CITYIZIP PHONE <br />14.j -J.&-A i�0;7 EIEKFr 7yob �;)<u74'�Kr <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />au5-�45T) <br />CONTRACTTOR ADDRESS CITYIZIP PHONE <br />/"T Hr- 7. QoX /2O)-7 Ct/La77" y;)r-87� <br />CONTR. LICENSE #. <br />/f/`7KCb'C yfs�ut3 1, i <br />v-�/4S <br />USE OF BUILDING g Ej /Di /I'rhf� <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />U P� /: /' <br />_ Electric XGas _ Other <br />WORK DESCRIPTION <br />(pNs�uGT <br />W,pi.) PREY <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />(o <br />Toilet <br />A/C — air handling units <br />Bathtub' <br />Forced air systems <br />b <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />1, <br />Water heater <br />2 <br />Kitchen sink 8 disposal <br />— <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Z <br />Clothes washer <br />Laundry tray <br />Y <br />Clothes dryer <br />Range hood <br />Sink (service/bar/mop/etc.) <br />(ti,W <br />Exhaust fan <br />_ <br />Backflow preventer <br />— <br />Heat pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />_ <br />_ <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE 15 3105 <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 />ordinates 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 stale 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 />Slate Contractors Law 18.27 RCW and 296.200 WAC. <br />�.�r1,111), .a /-3- o � <br />Signature of Owner/Contractor/Authorized Agent Date <br />1A)23c'-� <br />9fZ��)j <br />