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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-vnvW.everettvva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS S PARCEL TAX I.D.# PERMIT# <br /> (LI (0 4U1hSa.sv d3�1 a0 Z003 L0o7 �(v <br /> LEGAL LOT NO, BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESSCITY/ZIP PHONE <br /> 52fo on arc nJu blit C' 2 N me u <br /> TENANT NAME CONTACT FOR PERMIT '�D(r (7/1 I— q6 NE <br /> Lom 60\ P; -� KCS T°YrG -1, YJ _j 126 -��7�11 Ny <br /> CONTRACTOR �Vtrjrz fh V44,1 O)OM t/GA ADDRESS 121 •Ill fr CITY/ZIP PHONE <br /> CONTR.LICENSE# 5Vr( f, n , �C,/ pZ <br /> USE OF BUILDING (/l, 1�'1. ! '1 r HEAT SOURCE 7 CONTRACT PRICE OF WORK <br /> — yc. <br /> Electric _Gas_Other I0 GGA• <br /> WORK DESCRIPTION (T) <br /> VW InaW. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM rNO. 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 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> __ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(servicelbar/mopletc.) _L Exhaust fan <br /> _ Backflow preventer _ Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> _ Grease trap _ Woodslove <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 lhority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> constr on 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 tractors 16.27 RCW and 296.200 WAC. <br /> 7112146& <br /> ig re of Ow / ntractor/Authorized Agent Date <br />