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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 PARCEL TAX I.D.# PERMIT# <br /> �CcU IL S L /A I'(-) cx)3"+ -3,-,60 d <br /> LEGAII <br /> DESC. LOT NO.U BLAcK TRAY o r' 3crx�f� P.�i Jo <br /> OWNER �C ADDRESS CITY/zip PHPNE <br /> �,()(nnJ C' n1 GL L <br /> TENANT NAME CONTACT FOR PERMIT f PHONE <br /> CONTRACTOR 4GrOMCC ADDRESS CITY/ZIP PHONE <br /> � . (-� S T.r' <br /> CONTR.LICENSE# C AR )-(T 4EYL/ 62C--' )ee' s'd�✓cam-yid-''f <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Sri? _Electric as_Other 15 Z� eJo <br /> WORK DESCRIPTION <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) 1 Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal I Gas fireplace <br /> 1 Dishwasher = Gas range <br /> 1 Clothes washer ( Clothes dryer <br /> Water healer ,f Tr— Range hood <br /> _ Sink(servicelbar/mop/etc.) —�1 Exhaust fan <br /> _ Backfew preventer Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boller <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> Other <br /> I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby cerilify that l have read and examined this application and know the same to be true and correct. All provisiol,s of laws and <br /> ordinates governing this type of work will be compiled with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the p s10n of any other state or local law regulating construction or the performance of <br /> construction.That I em authorized by t owner of Ihis property to perlorm a work for which application Is made and I comply with the <br /> Sr �rs Law 18.27 ROW a 296.200 WAC. <br /> ►� Z ' <br /> gnature o r/Co rector uthbrizdd Agent k Date I l <br /> Z <br />