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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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />t t9 f�5� <br />PARCEL TAX I.D. Y <br />PERMIT i <br />LEGA LOT NO. <br />DESC. QZ <br />BLOCK <br />,,00 <br />TRACT <br />TRGad M—S ON <br />OWNER ADDRESS CITYIZIP PHONE�25_ <br />Chevy L . `IwvlcA t5\ \ (o "`ss 5E Efso- o -8731,0 <br />TENANT NAME <br />m& <br />CONTACT FOR PERMIT PHONE <br />WtCkCr L 9,/fz- y25.ZC-f&SZ <br />.QITYPPHONE <br />PWLICv CcN"ETE CQrQepl> %�c. ar> L�U-^ <br />OCZAPPur, 556U (:R39 iz��4 /JE `-Iz5 z1C-U)3Z <br />�rUSSE OF BUILDING <br />"�'�L 'J <br />I — HEAT SOURCE <br />Electric Gas Other <br />CONTRACT PRICE OF WORK <br />7� 0 <br />WORK DESCRIPTION <br />Rove excsllvj-&rVac� I ►nd cln�lrnv�ey p rQ �� <br />0� -erVck qV?- k e aV):A do twice <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />MECHANICAL <br />NU. TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbar/mop/etc.) <br />Backgow preventer <br />Urinal <br />Drinking Fountain <br />Fluordrain <br />Grease trap <br />Roof drains <br />Other <br />_ <br />_ <br />_ <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />oodstove <br />Other <br />m <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />1 hereby cenlify that I have read and examined this application and know the some to be true and correct. All provisions of laws and <br />ordinaces govei ning 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 />constructi .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 />rState Cent ct rs aw 18,27 RCW and 296.200 WAC. <br />ature of /Own r/ or rector/ uthoneed Agent Datel <br />ro ry" n�c I rnr- <br />