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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 <br />PARCEL TAX I.D. 0 <br />N <br />1515 <br />/P�IE^^RMIT <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. -/E'r- <br />OWNER <br />ADDRESS <br />CITYfLIP PHONE <br />-a11 <br />. `;33 9 <br />1LC <br />ISUI II bod-,14` <br />S/i.�F,..i1=�1//n 'IAt'AD <br />TENANT NAME <br />CONTACT FOR PERMIT <br />PHONE <br />.A1/rt�?.�4 E L <br />I�Ar?R S(4 IJ F-u3PUEQ <br />c�OF.- 7f�r, u•%5"/ <br />CONTRACTOR <br />ADDRESS <br />CITYMP PHONE <br />GA6[XA,0J5 El r/9 •/ZC9t T. /C, <br />i'O $ux 11041 �S..vI[tE 4Roid2 'Y.P5 •A/Ill 7-.s13i9 <br />CONTR. LICENSE N <br />n I <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />cJ rr_TC E/ l�n rTE HGU;i'� <br />_Electric ?� Gas Other <br />WORK DESCRIPTIO�=I,, STN�I. Ll) <br />IZoc,'Trp Gq3 �'��AT <br />ICKgGS KXr.rD A"-air=�R7L`Q <br />}�VCTb.I•i�K 'TCl (.�yOiTSe.V <br />T/y� ���Gf�CCy! Q'lr�<:.'✓E /i/✓� �;r�fc'4%M,3 <br />2l �x%2=N0 17 FrcTtJ�..?K lS�I.M i//� 1=xS3'T 2'�/6- <br />Fx H/�f U:�: ��.✓ 'G 7-A4 <br />PLUMBING <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />TNO� <br />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/mopletc ) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />A/C - air handling units <br />Forced air systems <br />Gas piping CL *✓ -'LE : <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan (Auk— o✓cr) <br />Heat pump <br />Unit heater <br />Baler <br />Refrigeration <br />Woodstave <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby centify that I have read and examined this applicat,�n and know the same to be true and correct All provisions of laws and <br />ordinates governing this type of work will be complied vath 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 o. local law regulating construction or the performance of <br />construcbpK.7at I am authorized by the owner of this property to perf,am the work for which application is made and I comply with the <br />State ntr ctors Law 18 RCW 109 .200 WAC. <br />Sign re of Owner/Contractor/Authorize gent Date <br />