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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />F 3200 CEDAR STREET, EVERE—T, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERM)T # <br />{ SZ 15 75 sal c5 t vo I -'I.�' <br />LEGA LOT NO. BLOCK TRACT A <br />DESC. 4?S-3 - 3`T9 <br />OWNER SU - ���ADDRESS CITY21!' PHONE <br />5 2-115 5 .9,w sr lyo nkE4L&w t t A; q 8 Wb <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />CONTRACTOR �T � ADDRESS CITYIZIP PHONE <br />�V�o►�s�,"P-v�-�,�1 33c� c�sT�vr <br />CONTR. LICENSE# 5VI5*k i VA-. 4ZS-ZS�-91Q <br />USE OF BUILDING I — HEAT SOURCE ��A J <br />CONTRACT PRICE OF WORK <br />� tOD� �1"{ Ar Electric Gas Other A 2 two I f70� <br />WORK DESCRIPTION <br />iJ6UJ Lt��fy1►�v ��- , <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />_ Toilet A/C - air handling units <br />_ Bathtub Forced air systems <br />_ Lavatory (wash basin) Gas piping <br />_ Shower Water heater <br />_ Kitchen sink & disposal Gas fireplace <br />_ Dishwasher Gas range <br />_ Clothes washer Clothes dryer <br />_ Laundry tray Range hood <br />_ Sink (service/bar/mop/etc.) Exhaust fan <br />_ Backfiow preventer Heat pump <br />_ Urinal Unit heater <br />_ Drinking Fountain Bailer <br />_ Floor drain Refrigeration <br />_ Grease trap Woodstove <br />_ Roof drains Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify 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 />r^ give authority to violate or cancel the provision of any other stPre or local law regulating construction or the performance of <br />truction. That I am authorized b the owner of this property to perform the work for which application is made and I comply with the <br />-,ate Contractors Law 18.2 of 296.200 WAC. <br />Z ?'Lib <br />Signature con ontractor/Authorized Agent Lists <br />Vti, <br />