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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 />/" 09 a-7 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />Z- lly i</5f-lve„e//,A-1A 91V- <br />PARCEL TAX I.D. # <br />DOI z cell0Z-q oo <br />P I�MIT # �) <br />17�j -1 <br />LEG A LOTNO. <br />DESC. z <br />BLOCK <br />Pi/l/ <br />J�ACT <br />�tL�l-yf- �r ✓ <br />Yib�G <br />OWNER ADDRESS CITYMP PHONE <br />/. <br />�i-°t` �4-9tte e✓ Z-1 71kt £✓ere# 471.c9'5 270 Z/S4/ `70�12 <br />TENANT NAME CONTACT FOR PHONE <br />,PERMIT <br />('ko LlE 1>/cY �' ZuLG. 11 e,' ee 270 Ks/f `i0 LZ <br />CONTRACTO ADDRESS CITYIZIP PHONE <br />S e.( <br />CONTR. LICENSE -7 Z 13et)Pr47 Let k °e- �-✓Pre If <br />.7It) KS'q `ldLZ <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF 10.4 <br />l7 1— k <br />_ Electric Gas _ Other <br />`'A �Gr 0%6%G' <br />I <br />WORK DESCRIPTION Lo <br />V <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />—L <br />Tollet <br />A/C — air handling units <br />Z <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping (I! <br />Shower I <br />/ <br />Water heater <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry trey <br />jk: <br />Rangehood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan I <br />I <br />Backflow prevenler <br />Heat pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boller <br />_ <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />Other <br />I <br />CITY OF EVERETT LOCAL SALES rAX CODE IS 3105 <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 ,.Id <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not r,resume <br />to give authodty 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 />Stet ontrctor!w 7 7 RCW and 296.200 WAC. <br />z/l1, 71 <br />signature of owner/Gontra=Mthanzed Agent Uate <br />-),-)w 0a05--- <br />