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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 />LEGAL LOT NO <br />BLOCK <br />TRACT OR SUBDIVISION # <br />"". ), y /Olr 04-1, <br />J 3 <br />LV= _ <br />OWNER ADDRESS CITY/ZIP PHONE <br />M,a T i CW IC Inn.TCL'✓trh--tr!jC2oP 209 qlC f r95`Ji <br />TENANT NAME�r CONTACT FOR PERMIT PHONE. 40�r 33 Q cl-7 b L <br />'' II <br />E•MAILDC g0fdV;W00(JMiVgj <br />PF��NE �IIFj <br />CONTRACTOR ADDRESS C17Y/ZIP <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />�Eleclric _Gas _Other <br />/r J I� �� <br />w <br />WORKDESCRIPTION gLACt= PRe-- CkI f; oG. Arnchlc) (Ji%jC e <br />4 If It FROV, POR(H, S1kFPS 4-ROOF tu"EAPit2CW <br />IIll <br />KE;I'1,� CF_ w1 FIACi.�� W ��hn L W gjbCWS — NotjtSIN RaQoomr OR <br />_PArcmeor <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 />Bathtub <br />Forced air systems <br />E— <br />Lavatory (wash basin) <br />Gas piping ^� <br />Shower <br />_ <br />Water heater / <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range (� <br />_ <br />Clothes washer <br />Clothes dryer <br />Water heater <br />�,(%� <br />Range hood ` <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan �1 <br />Backllow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify that I have read and examined this application and know the same to be true and correct. A!I 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 slate or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this properly to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAG. <br />A /0•,2 y�S <br />Signa! re of Owne onlra dAulhorized Agent Date ' IZ <br />