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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-E810 — 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. t <br />PERMIT r <br />LEGA <br />LOT NO. <br />140 <br />BLOCK <br />TRACT OR SUBDIVISIONt \ <br />C ,Jan Ccty� Ccrck) 1 <br />DESC. <br />� i i . , 1' . , i 1, ¢ <br />OVRMR ADDRESS <br />CL-L G =)11 (! 6t!'1 ky,, I �Wjjr 1 C weff %Wt LI IS '117 Vto <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE L17S 1 SIL 4 if IL`► 3t2 <br />C 1 <br />' �Lllij�Ur1Q �C CMF� E-MAIL `.,, ra .4 f C qaat 3W <br />ADDRESS <br />(cult'►,by5tCcrx�yt nfl <br />18�ro0 ��Av{. lJlnl A -3c; 3 <br />CONTR. LICENSE R <br />eiA Ci',t�•Pf <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />deirrflift I6MIC0 <br />I <br />I <br />Electric _Gas _. Other <br />kilt lit <br />— <br />�it <br />WORK DESCRIPTION <br />kI) -1�vr - I ^' �' t l�• ) <br />1I <br />I V)C <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />T <br />A/C - air handling units <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />I <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicethar/mop/etc.) <br />= <br />I <br />F; <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />I <br />o <br />Badkgow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />_ <br />_ <br />_ <br />_ <br />_ <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other — <br />— -- <br />_ <br />_ <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritity that 1 have read and examined this application and know the same to be true and correct. All provisions of lays and <br />ordinates 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 slate or local law regulating construction or the performance of <br />construction. That 1 am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />We Contractors Law 10.27 RCW and 296.200 WAG <br />� 1 t✓ <br />ignalure of Owner/Con-ir-a-Ll-o-r/Tu-tFio—OFe-d Agent a <br />,0) <br />