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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 99201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM j _ a� _0 i <br />SITE ADDRESS <br />jKZU 7 <br />PARCEL TAX I.D. p <br />PERMIT p <br />�i" St 5E �'� <br />i1C) 920000� loco <br />l�� U-f 053 <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUu DIVISION p <br />DESC. <br />OWNER <br />ADDRESS CITY/zIP PHONE u -Z S <br />aA <br />a2s 9tit"S'j 2 r-��� �1�s2� 3,y-haCz <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />�+ <br />(Lz`,C/y <br />E-MAIL <br />CONTRACTOR <br />CONTR. LICENSE p <br />ADDRYS§-- CITYIZIP PHONE <br />USE OF BUILDING <br />HEAT SOURCE <br />CONI RACT PRICE OF WORK <br />Electric —Gas —Other <br />WORK DESCRIP110N <br />1_��1� ��S <br />�1 � ; \ `JCi t'v �-'�—) �il Will •�--.��.-,� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washor <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (servicolbar/mop/otc.) <br />Exhaust fan <br />_ <br />BackBow provenler <br />Heal pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease Trap <br />_ <br />Woodstove <br />_ <br />Roof drains <br />_ <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby corillfy that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces 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 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 I comply with the <br />Slate Conlractors Law 18.27 RCW and 296.200 WAC. <br />