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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 -wvdw.everettvva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D. # P IT <br /> �— -1 S T `S is X039 3 2- - ov 2- -(D- , 1 -coo C 0)2- <br /> CEGALL LOT NO. BLOCK TRACT �`,� L 2 X71 n ��- <br /> oESC. a 3 _ QEV �-�-4L-C S 0ay- <br /> OWNER AODRESS CITYIZIP PHONE <br /> OyyAcv Q��� il,��s Com~ . 39aa t3—JL ,QF E�cszcTr OS ILIK-311--730 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRA TOR, ADDRESS CITY2IP PHONE <br /> I Ivy Vic- �r�rHE 9S G!) `,T• 3y ad 8.1tt'AvE •Jr aftrrl 9 �5 q2,5- 3c:7-7360 <br /> CONTR.LI ENSE b <br /> �Ar30c)taDz <br /> USEE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> J F� _Electric Gus_Other I odk <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM HO, hPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> f Bathtub Forced air systems <br /> j Lavatory (wash basin) _ Gas piping <br /> -�-- Shower Water heater <br /> I Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink (service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodsto ie <br /> Roof drains Other <br /> _I Other — <br /> CITY OF EVERETT LOCAL aALES TAX CODE IS 3105 <br /> I hereby cent.ty that I have read and examined this application and know the same to be•.ruo 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 presume <br /> to give authority to violate or cancel the provision of any other state or local law reyulating construction or the performance o' <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 /> Stat ractors La 8.27 RCq and 29 O VJAC. <br /> Date <br /> Signat re of Own onnac or/Au ho Ag t L <br />