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PERMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR <br />STREET, EVERETT, WA 58201 <br />425-257-8810 <br />— FAX 425-257-8857 — www,everett.va.org <br />APPLICATIONS <br />ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />- i I J E`k E 1 <br />PARCEL TAX I.D. p PERMIT # <br />1 & 44Y ',2 K l -100 S =� <br />LEGAL LOT No. BLOCK <br />TRACT <br />DESC. I21 Z <br />191sio4u2s; Div, A <br />OWNER <br />ADDRESS CITYIZIP PHONE <br />b,A ' u 11./L5 r <br />445 -3 �_ `/ r, r <br />TENANT NAMEI <br />FOR CONTACT PERMIT PHONE <br />I G ��. 57&v,(, <br />- <br />CONTRACTOR_ ow <br />_ <br />ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE 0 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I <br />— Llectric Gas Other <br />I <br />WORK DESCRIPTION <br />Om►o\/k, &' 644A68%3 A -NA) "OP <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Laundry tray <br />_ <br />Range hood <br />_ <br />Sink (senlco/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backfew preventer <br />_ <br />Heat pump <br />_ <br />Uriaal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boller <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cedlify that I have read and examined this application and know the same to be true and correct. All previsions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. The granting of d permit does not presume <br />to give authority to violate or cancel the provision of <br />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 />Stat Contractors Law 18.27 RCC�W and 296.200 WAC. <br />6&""-J <br />— ( SS - <br />Si nature Owner/Contractor/ ut o eAgent <br />Date <br />