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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 <br />SITE ADDRESS ,L I l u A q 51 • <br />PARCEL TAX I.D. N <br />PERMIT N <br />eije.re--lirl VJA gZNZ0.3 <br />oO5y5LL'q`IvUlo'L <br />I- 12•U0' <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS t CITYIZIP PHONE <br />B A, NJ ; e_l s e-n Z Z9 o ti' 9 — 3 r: P 1. W � L�.Y1� .d3, & A 9 is L 2 . <br />r« ci . <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Oct a.A4- <br />I 5rwd A,t-'Ien (-col.)g14-8L;Go <br />- <br />ADDRESS CITYIZIP PHONE <br />CONTRACTOR �o t._(r\el- <br />OMw <br />CONTR. LICENSE 0 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />1 r <br />Electric _ Gas _ Othe, <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />AIC — air handling units <br />Bathtub <br />_ <br />Forced air systems <br />X <br />Lavatory (wash basin) <br />Shower <br />_ <br />Gas piping <br />Water heater <br />Kitchen sink 8 disposal <br />Dlahwasher <br />Dis <br />Clothes washer <br />Laundry tray <br />Sink (service/berlmopletc.) <br />BackBow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />- <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />1 hereby ceritify 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 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 />Stat ontractors Lew 18.27 RCW and 296.200 WAC. <br />I� <br />rn� <br />o <br />S gnature o Owner/Contractor/Autnorizea Agent Date <br />