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PE,MIT APPLICATIOw <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 -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />Gll 7q'N' Gd <br />PARCt. TAX I.D. # <br />-' <br />PERMIT <br />1_rvele� � <br />0vs � <br />LEGA LOT NO. <br />BLOCK <br />RACT <br />DESC. <br />a L ( <br />v <br />OWNER a� �ADDRESS CI�TIY2IP PHONE 2 � O <br />�Yc d(6�T e1'L+II' Zllg/r 9d'203 '-tSY 9 0zZ <br />TENANTNAME <br />CONTACT FOR PHONE <br />`/1 0 U� I <br />tIPERMIT <br />bU w c4-4.au4tPY 27n Lr<1z/ 0► D z z <br />CONTRACTOR ,� AD(�DRESS CITY/ZIP PHONE <br />PY' 270 <br />CONTR.OICENSE M'UI'l <br />�// / 7y"-A- !F(fA0# GI$Z03 <br />USE OF BUILDINNG <br />HEAT SOURCE <br />CONTRACT PRICE <br />I- t? (� (JL '0V1G P <br />Electric —Gas —Other <br />,OpF�WORK <br />WORK DESCRIPTION q <br />d� iM 01 1 %2� .Pd-I �-4,� '-�u ,_' J_u S�C -4- h P In.1 ot,V- 47LML- <br />PLUMBING <br />MECHANICAL <br />N0. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C -air handling units <br />I <br />Bathtub <br />_Forced <br />air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />(— <br />Kitchen sink 8 disposal <br />Gas fireplace <br />I <br />Dishwasher <br />� <br />Gas range <br />_ <br />Clothes washer <br />_Clothes <br />dryer <br />_ <br />Laundry tray <br />_Range <br />hood <br />_ <br />Sink (service/bar/mop/etc.) <br />ran <br />_ <br />Backflow preventer <br />_Exhaust <br />_Heat <br />pump <br />� <br />Urinal <br />heater <br />Fountain <br />_Unit <br />Boller <br />=Drinking <br />Floor drain <br />� <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_Roof <br />drains <br />Diner <br />� <br />Other <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE 19 0105 <br />I 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 o/ 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 />I State (Contractors 2296.200 WAC.tW <br />Signature o caner ontractorlAuthonzed gent ate <br />