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A( �.. <br />PERMIT APPLICATIvN <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 />NC6ia-CX1 <br />1-) Ae5,5' <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE , <br />r VII Zab- U <br />V� ({tC CL,,A"- IA,(- i"'-_ <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />ROW �L)klJ6L P1.kr-,Niv l N�-%YC`rCF/!- <br />CONTR. LICENSE <br />� r <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I <br />— Electric �Gas _Other <br />I w yid <br />WORK DESCRIPTION //�� /j <br />ltAci-t l(�ln. Yti/ �r1:. �HVv�- /�Ii!/J✓ d✓/1 I.✓( �%nIL. <br />✓um'I.IA1l <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />2 <br />Toilet <br />— <br />A/C - air handling units <br />Bathtub <br />_ <br />Forced air systems <br />Z <br />Lavatory (wash basin) <br />X <br />Gas piping <br />Shower <br />— <br />Water heater <br />_ <br />Kitchen sink & disposal <br />— <br />Gas fireplace <br />_ <br />Dishwasher <br />— <br />Gas range <br />_ <br />Clothes washer <br />— <br />Clothes dryer <br />Water heater <br />— <br />Range hood <br />I_ <br />Sink (service/bar/mop/etc.) <br />— <br />Exhaust fan <br />Backflow preventer <br />— <br />Heat pump <br />_ <br />Urinal_ <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />-� <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodslove <br />Roof drains <br />Other <br />Other <br />— <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. All provisions cf 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 v or cancel the provision of any other slate or local law regulating construction or the performance of <br />construcM Thal am uthor by the owner of this property to perform the work for which application is made and I comply with the <br />. <br />o actor La 18.27 C and 296.200 WAC. <br />Sign t ner/Contractor/Authorized Agent Date <br />