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�— PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 4t5-257-8857 - www.everetlwa.org <br />/ r - APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS I PARCEL TAX I.D. N ERMIT N� <br />�1h 5v. 03a 'lioeaozc& �3 <br />LEGAL!LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS CITY21P PHONE <br />jz o Can,M-e. ce (&-J, tic yP- 2 rvr 1,+1T 5f��i , GFrrr <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />—(arvl <br />S1146IIkr 61ovo K00 7,,,-7Er-174q <br />CONTRACTOR L "r.C&1 pe)ry,q('I^111601 ADDRESS 7L7 j. rt-t" 34 CITY21P f( 44�1Ai PHONE 76 f 710- 'Y <br />CONTR. LICENSE# Cq e�VLCA 41 QZ <br />USE OF BUILDING f HEAT SOURCE CONTRACT PRICE OF WORK <br />�u <br />Electric _Gas Other 3 00G <br />_ — r <br />WORK DESCRIPTION <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTU'E OR ITEM <br />Toilet <br />_ <br />A/C - air handling units <br />_ <br />Bathtub <br />— <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Water healer <br />_ <br />Shower <br />Kitchen sink 8 disposal <br />— <br />— <br />Gas fireplace <br />_ <br />Dishwashar <br />— <br />Gas range <br />Clothes dryer <br />_ <br />Clothes washer <br />— <br />Range hood <br />_ <br />Laundry tray <br />Sink (serv'^sPoarlmopletc.) <br />L <br />Exhaust fan <br />_ <br />_ <br />Backflow preventer <br />Heal pump <br />Unit heater <br />_ <br />Urinal <br />Drinking Fountain <br />Boiler <br />Refrigeration <br />_ <br />Floor drain <br />Grease trap <br />Woodslove <br />_ <br />Roof drains <br />Other <br />_ <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 0105 <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 />herein or not. The granting of a permit does not presume <br />ordinates governing this type of work will be complied with whether specified <br />or cancel the provision of any other slate or local law regulating construction or the performance of <br />to give out. grily to violate <br />by the owner of this property to perform the work for which application is made and I wmply with the <br />constfucti 4amuthorized <br />State Co cWand290200WACIgn <br />Agent Uale <br />to uthorized <br />