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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 /> r" L. 5E 91vd <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION 0 <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE IS Z. <br /> eve0�61r yoasove7 ;Pa. &ex /SYS- XrCzg,*r. Wlt- 9 eo(o <br /> TENANT NAMEI�i Af,04 CONTACT FOR PERMIT PHONE Ytf-•J.SOS. - //2/ <br /> L3� <br /> /'J O ZTbA 6Z0CITYIZIP OP E-MAIL <br /> TFtA <br /> CONTR.LICENSE# [�,� e PIP <br /> JLLi?— <br /> USE OF BUILDING NEAT SOURCE 1 . CONTRACT PRICE OF WORK <br /> ✓ Electric _Gas_Other 14 <br /> WORK DESCRIPTION <br /> ^1ov k f fvli cn , lx./i6s�►+, g"r c� �.11, f ori <br /> I <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 1 Water healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> 1 Dishwasher Gas range <br /> 1 Clothes washer 1 Clothes dryer <br /> Water heater I Range houd <br /> _ Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> 1 hereby ceritify that I have read and examined Ws 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 -ranting 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 /> State Contractgrs Law 18,27 RCW and 296.200 WAC. <br /> Signature of Owner/Conlractor/Authonzed Agent 'Date ' I <br />