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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8310 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. 0 <br />PERKIIT p <br />jqtO <br />LEGAq LOT NO. BLOCK <br />TRACT <br />DESC. <br />u <br />OWNER ADDRESS CI1Y21P P�H}")�ti,Z <br />G%Jre-r,ICO A0l l�;i:6 Ll G !r-/IG, 'i�G't'-ST sLJ 57C ""A /=k:tT'{ t✓4_ 9' C <br />TENANT NAMEE� <br />CONTACT FOR PERMIT PHONE <br />(uf c-LA `Lr�.15�PJC-�I�wt <br />I Ctl r 1S401-eJ- ((;�)) 77f. <br />CONTRACTOR ADDRESS CITyIZIP PHONE <br />,Vet).; s�5., <br />CON_R�yMENSE 0 <br />77h-sy3S <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric _Gas Other <br />— <br />41 ! H 7.2 s? <br />WORK DESCRIPTION <br />pc.;w%d PUG LC1(c,t3 <br />PLUMBING <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C - air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />_ <br />Sink (service/bor/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backfiow prevenler <br />_ <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woods!ove <br />Roof drains <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby coritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates goveming 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 />Stale Contractors Law'18.27,RCW anY296.ZO AC. <br />Fej <br />�67 <br />SignirUre of Owne Contractor! uthonzedAgenl Date <br />