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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 PARCEL TAX I.D. # PERMIT # <br />C. <br />d-gO'W 21 sr 5T 5.53 ' U 1 Ltoo 670c, I , <br />LEGAL LOTNO. DLOCK TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />< L- 5'i F'��NCr o29, a4 ;21 sr 55 Ev7- 99-2ol <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />1 <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />DA � q-Ni7-jt:-F /'LmBG— I-H 6 q/��/�1 i3 Az �v �'�NLuzn qz�-�75I yVje <br />CONTR. LICENSE # V <br />_ � , ,�rp�tD vy cr✓l _ <br />USE CF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE WORK <br />_ Electric. -A Gas _ Other <br />�OfF� <br />WORK DESCRIPTION <br />REoc'46E <br />615 -Z:;,J srrn 1 g. zUc.9�-► cr nl . <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C - air handling units <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water healer <br />_ <br />Kitchen sink 3 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gasrange <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow prevenler <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />_ <br />Woodslove <br />_ <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. Ali 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 anv other stale or local law regulating construction or the performance of <br />:onslruclion. 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 />Stale tractors Law 113 RC�y%nd :100 WAC. <br />` -7 <br />M j,4 7 Cl / <br />, <br />Sig urt3 r of Owner/Contractor/AOiori2ed Agent Date <br />