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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 S AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.0 PERMITS! <br /> I S- 6o fh Sk . :�E o y7r7 060 oLq O'Y <br /> LEO LYT�,IJ `'( 000 D-Dy. BLOCK TRACT C t SUBDIVISION\ND o4 �CKCS <br /> DE6C. W7 Tr <br /> r !Ot t <br /> OWNER ADDRESS CITY2IP PHONE <br /> Cf,r ,S * Ann 0arcr.. .. r Si,; - d;q, r S.4- 9kZo 2 <br /> TENANT NAME CONTACT FOR PERMIT PHONE 4bs-rl Z6 0 <br /> is`L`� " GroK►`1c1s* E-MAIL <br /> TOR <br /> CONTRAAUUME55 1!TVIZIP <br /> CONTR.LICENSE a <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ('6 010( T _Eleclnc _Gas_Other <br /> WORK DESCRIPTION <br /> I L1 l <br /> �Q CG(1S1 ( Lkc `a( OLJ( � 1 �1'�-� Wr-5 16(IL( W <br /> -Pe (M;1- y r <br /> MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ <br /> Toilet A/C-air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> _ Shower Water heater <br /> _ Kitchen sink 6 disp3sal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Water heater Range hood <br /> _ Sink(servlulbar/mop/etc.) _ Exhaust fan <br /> _ Backflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floordrain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinances 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 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 /> Stale ContractorsL`aw,1�8.2 'RCW and 296.200 WAC. <br /> Signature of Owngr/CdhtrActodAuthonzed Agentat�S e <br />