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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.evereftwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM i - 7-0 --O°l <br />SITE ADDRESS <br />PARCEL TAX I.D. • <br />P 9mrr fl <br />rj't1d <br />Srst.J <br />0%If.��'_-<�11C�� <br />OLG <br />_',+'I_I <br />LE LO NO. <br />BLOCK <br />TRACTOR SUBDIVISION! n 1. 1 <br />C. en ccrcld / <br />SG <br />DESC. �. f <br />( i.'. i, Ir : l_1'n t'� a.r�l lcb✓'f <br />OWNER <br />ADDRESS T <br />�•I CVC, elf H lu15 217 2.20It <br />Yai,I;lul1,1, <br />( <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />I <br />E-MAIL � . u t•aT<•Ac d [L'imut W. <br />CONTR740TOR11. �. <br />' <br />.... r t ��1,, V <br />ICo1fj.G45(- crrm'%t .let <br />CONTR. LICENSE N r• <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />4,Y�I.r I, ,1, II <br />c+r� . l.,,ir',..�,� <br />Electric Gas Cher <br />I -- <br />I <br />I' t iU 1`i <br />— <br />WORK DESCRIPTION <br />I\1(61. 'l �i rY.� <br />)r'f`:,1 . •TJ� r, ,. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE <br />OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />_� <br />A/C — air handling units <br />Forced air systems <br />3 <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />_j <br />Water heater <br />I_ <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (serviee/barlmoptete.) <br />Backffow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />Z <br />_ <br />_ <br />__ <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust tan <br />Heal prmp <br />Unit heater <br />Boller <br />Reldgeretiun <br />Woodelove <br />Other,__ <br />—. <br />_ <br />_ <br />_ <br />y <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify that I have <br />read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type <br />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 <br />or cancel the provision of any other state or local law regulating co: slruction or the performance of <br />construction. That I am authorized <br />State Contractors Law 18.27 <br />by the owner of this property to perform the work for which application is made and I comply With the <br />RCW and 296.200 WAC. <br />3ignature of LnnenCornracturtAuthorizodgent <br />12 <br />ate— 1/ <br />1 <br />(471 <br />