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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CELLAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - wvvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT R CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. N P RMIT M <br />LE GA1 LOT NO. BLOCK TRACT <br />DESC. L i INC—I C CI —PHONE <br />OWNER ADDRESS <br />,,. ,: •ronlejCC. ' c,CrJ-ibirt L<_C- ITS 1. N� "1�1� `'T1yE9R115 (2r•>`i2S 7-r.,cc. <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />1 0;Le."zja•j-6T% ti �1N2o,__o GF41?45iYA'5sCfJ <br />r I { <br />CONTRACTOR ADDRESS CITYIaP PHONE <br />CONTR. LICENSEN <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric —'Gas —Other <br />'X L4" ""'— <br />U r <br />_ <br />WORK DESCRIPTION <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />-I— <br />Toilet <br />_ <br />AIC — air handling units <br />Bathtub <br />_ <br />Forced air systems <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Water h rater <br />Shower <br />Kitchen sink 8 disposal <br />_ <br />_ <br />Gas fireplace <br />_ <br />_ <br />hwasher <br />Gas range <br />Clothes dryer <br />Clothes washer �� <br />Laundry. tray <br />_ <br />_ <br />Range hood <br />Sink (seJvi(sbarlmopletc) <br />— <br />Exhaust fan <br />B ft(jw preventer <br />— <br />Heal pump <br />Ufina1 <br />Unit heater <br />Drinking Fountain, <br />_ <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />Woodstove <br />_ <br />Grease trap <br />_ <br />Other. <br />Roof drains <br />— <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby Cantify that I have read and examined this application and know the same to be true and coned. All provisions of laws and <br />ordinates governing this type of workwUl be complied with whether specified herein or not. The granting of a permit does not presume <br />of <br />to give authority to violate or cancel the provision of any other slate or local ILw regulating construction or the perfor—rice <br />to the work for which application is made and I comply with the <br />construction. That I am authorized by the owner of this property perform <br />Li8.27 CW and 2g8.2f� WAC. <br />trectOrsirevontra <br />%� �wt -- �GGo <br />Wignature <br />o or ut ongent <br />ill <br />