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i 2-2Sbi <br />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 ACCEPT ED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />83o ISO,, S4. SO. .4400 <br />/ <br />,2712- L <br />LEGAL LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />So,cL VG n4 �.rts <br />TENANT NAME <br />FOR PERMIT PHONE 4 yr % 6R - 3 t� <br />��lL� <br />t-CONTACT <br />V4JC �fC��L <br />f�o4_1co✓4l VC S. <br />J�C� <br />E-MAILOI <br />CONTRA %,'N^,.',6, 1Marc✓awl l ADDRESS <br />Re CITYIZIP NE— <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Lo" . Ac1e••-111 r 'i'ES�I�S <br />_ Electric X Gas —Other <br />2 3 ri <br />I <br />WORK DES :RIPTION <br />�t�\lti 1%Lv. 51 Ins;' �C,i t7. , A-r L,,tr , l,\oaku C. e <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C - alr 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 />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />_ <br />Range hood <br />I <br />Sink (service/barlmop/eta) <br />_ <br />Exhaust fan <br />1 <br />Backflow preventer <br />_ <br />Heal pump <br />Urinal <br />Unit healer <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />_ <br />Other 111-i- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby corilify that I have read and examined I1.1s application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this typo 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 />conWepthor176d by the owner of this property to perform the work for which application Is made and I comply with the <br />Stat8.27 RCW and 296.200 WAC. <br />e.L-P-A__1 12 1 '21(y -) <br />SjgdWo of Owner Contractor/Authorized Agent Dale <br />v <br />