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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 ppppEgg <br />PARCEL TAX I.D. N <br />PERMIT N <br />7 r rtd 9 S 0 <br />LEGAIJ <br />LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION f <br />ADDRESS PWNE <br />OrrWNERf C"V21P j L1lISl-�I�SO <br />( n / <br />�i ,'4- C. YJTI.I;AtJI-t .).'. t( JI It'C?K fr r)jlal <br />TENANT NAME <br />CONTACT FORPEIIIIIINT Pl10NE I-I1 S 2 •a t • , ��t �c) x oY s7 <br />I 4, •SLU rC JP..YW/ EdAA1L `• e\Y,..� C �i•mJ 4.d .r+ <br />WNTRACTOR AD new CRY <br />�sw•.r•� l..u• lei. 1�''N 5 A••e� N�.J <br />r:oNrR.LICENSE! A 5 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric _pea _Other <br />WORN DESCRIPTION <br />INd <br />MECHANICAL <br />NO TYPE OF FIXTURE OR REM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C -air handling —units <br />Bathtub <br />� <br />Forced air systems <br />Lavatory (wash basin( <br />_des <br />piping <br />Shower <br />-j_ <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />� <br />Dishwasher <br />Gas range <br />� <br />Clothes washer <br />-A— <br />Clothes dryer <br />0 <br />Water hector <br />Range hood <br />Sink (servicebarlmop/elc.) <br />ry_ <br />Exhaust tan <br />�_. <br />Backgow prevenler <br />� <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boller <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease Trap <br />Woodslove <br />_ <br />Real drains <br />_Other <br />Other <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritily That 1 have read and examined this application and know the same to oe 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 riot 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 />SIatA,Contradors Law 18.27 RCW arx1296.21X) WAC. <br />Signature o Owner/Gontractor/Authorized Agent ate <br />