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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 ADDRESS PARCEL TAX I.D.# PERMIT# <br /> (a&00 N1 C2 R,�t,� 9 c:r� �- v,� 2 i3 c y c Z�}� d o t Z o oHog _ 01 D <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> 4 G A w L( l,L"T Z� 1�i- P() P7� ooS f , S N o2 ,,)o wA q10) 046 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Tole z z ` S <br /> E-MAIL �3 v Lt-^ Q <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE ��,�5��Gf ^•�•�^" <br /> i(P-Ct'k (L (�^�S r+�u s~���► "7 3 55' '�. Z-0%, 5 r KL ,.� ►✓n �t b o z, <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION O d r r of C X 1 S)-1/%,/45— (y'fL- 1L. �f �C�Fj) `>eT j e-LC-IL 1/YA4 <br /> /I tt C-40 5 1./%/ New A t& O v'+A/C / ,-06,ff_ - (4 P. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> sea--"j V-i_C(LC. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinances 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 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 /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> Signature of Owner/Contractor/Authorized Agent Date <br />