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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 3 —1 Q --D �f <br />SITE ADDRESS <br />PARCEL TAX I.D. N <br />PERMIT, <br />-u <br />2y/.S 1 5T5[= <br />00 i7� ,� �a P <br />Il� ��c> <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION 0 <br />DESC,//� - <br />7 <br />OWNER ADDRESS CITYIZIP PHONE <br />A///Lr/ L'UZTX/it�> C.r= 3�2 1//L4 5T L11U4'crL' VzS 7#F7-/ <br />TENANT NAME ICONTA T FOR PERMIT Lf PHONE <br />�J_,/L�7fr2 GG <br />N , /' <br />%E / `%�/S�'�Z 1'%'S O� J Z� � �b 3 E.MAIL <br />• CTTYiYfFFAbA�— <br />f!!llidf/s NFi471 /7 �/ q2 l /zs�3ss'-907 <br />0� 4;o <br />CONTR. LICENSE M /- v r] / JJ� / 1;l, �l � d,� <br />USE OF BUILDING <br />HEAT SOURCE <br />ONTRpACT PRICE OF WORK <br />_ Electric _,Las _ Other <br />WORK DESCRIPTION �. !� �s f fray( 1/P FTP-O/L% <br />/Nfl�-t G �� lv�►Ts� T/��/K/ epy`'�i�j i-v�.c��G� �'l�c. <br />cF <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C - air handling units <br />_ <br />_ <br />Bathtub <br />Lavatory (wash basin) <br />T <br />Forced air systems <br />Gas piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />Water healer <br />Range hood <br />_ <br />Sink (service/bar/mop/etc,) <br />_ <br />Exhaust fan <br />_ <br />BackBow preventer <br />Heat pump <br />Urinal <br />Unit healer <br />_ <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodstove <br />_ <br />Hoof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceridfy that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified heroin or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other stale 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 1 comply with the <br />Slate C ntractors La� 18.27 RCW and 296.200 WAC. <br />,'!c 74, 3 "/ 7109 <br />Signature of wner! onlractor/Authorized gent Date <br />J'G <br />