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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 <br />PARCEL TAX I.D. # <br />PERMIT # <br />,J <br />I y �U *l(j, S .� 5 u' '�+" <br />U G / o Z 6 LPOSID5 <br />UCJ� <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />/ / <br />LY01-+J 'Fpfd �Q`� CA11d 1 L f26,hJ e- <br />TENANT NAME <br />I CONTACT FOR PERMIT PHONE <br />E-MAIL <br />CONTRACTOR 64 � —11-10 I <br />CONTR. LICENSE # D N.J Qg P / /4' J IT A%r /j 6 J15 (3O��E/I (Na <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I — Gas Other <br />3 � 6 n — <br />`Electric <br />WORK DESCRIPTION rT e)V� f N• R 17 # rO <br />1V <br />Li 4e7 ,�• 1, 4e_y-- <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />L <br />Tollel <br />A/C —air handling units <br />Bathtub <br />Forced air systems <br />�_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />_ _ <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/olc.) <br />Exhaust Ian <br />BackBow preventer <br />_ <br />Heal pump <br />Urinal <br />Uml heater <br />Drinking Fountain <br />Boiler <br />Flrordrain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 />ordinaces 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 w: ich application is made and I comply with the <br />Stale Co tractors Law 18.27 RCW and 296.200 WAC. <br />�ar� iyurG'ror r et 5 C9 <br />Signature of Owner/Contractor ruthorized Agent Date <br />