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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., FM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ACDR9SS PARCEL TAX I.D.# PERMIT# <br /> _ ' .acl - I'A PL.• SE "1 PO eSrl�'► yoco <br /> LEGA LOT NO. BLOCKTRA-T <br /> DESC. •�_ o '�1 OSIdtg - <br /> OWNER ADDRESS CITyfZIP PHONE <br /> EEr.�+�k1 wq. IgOL -t 13- I. 1l & <br /> �dtc,%2 '��n�-`.(Z'u.an ��03.x--s e'Au*SE � <br /> U• <br /> TENANT NAME CONTACT FOR PER141T PHONE <br /> �1a5 tV�o-t1,tSr•. <br /> CONTRACTOR ADDRESS CITy21P PHONE <br /> h, Jcttrr.0-:yv y�u,x> � 1`lo3x 3s'Ao.Se. 3tr1t. 4bot� . 4as173 -1112 <br /> CO TR.LICENSEN <br /> D , Y �I_c <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> !itR�jt`i A c�w�-1a1 J�aNs+�-^L� <br /> Electric Gas✓Other <br /> WORK DESCRIPTION <br /> 'N� W �o-v�4�'>•N..c.�t lrv- s{' -flw-•.a,Cl '�' ��Si� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 'b Toilet A/C-air handling units <br /> 3. Bathtub / yk .,cam Forced air systems <br /> L Lavatory(wash basin) Gas piping <br /> Shower 1, Water heater <br /> I Kitchen sink 8 disposal I Gas fireplace <br /> L Dishwasher % Gas range <br /> I Clothes washer I Clothes dryer <br /> Laundry tray I Range hood/(rl t 2r <br /> _ Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow proventer 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 7105 <br /> 1 hereby ceritify 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 /> to give authority to violate or cancel the provision of any other state 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 Contractors Law 18.27 RCW and 296.200 WAC. <br /> ow <br /> iS g�ra or uwner/L;ontractor/Aunnzed Agent Uate <br />