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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 /> 432-c S. '`f A-`-� 00 S-06')`:/ C b7C2 , 00 ( 7i2 -� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. 2 1 4 2-7- V 0 7 LO LL 6)v4 u,. A <br /> OWNER ' ADDRESS CITY/ZIP PHONE <br /> z.ir 25 o--y)� <br /> AJ 6433ui S g2-5- S- y / r E.�E2 /' 4BZ0) <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> CONTRACTOR /-/}C =r CAE' 4G ts' /.v ADDRESS Z-22 le, I/ZIP PHONE <br /> CONTR. LICENSE# p �-61 0 y20%•.J e � �� 5�2c'I <br /> 5725 5r)s <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I/ Electric Gas Other 8, 600 .0 6 <br /> WORK DESCRIPTION <br /> (ON ST(LA-;'e-T (i) '3 eor-boM /u/v�sse. �- A-' Ft>uAizA- J <br /> PC1-002 Sy SInfri <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&disposal Gas fireplace <br /> Dishwasher Gas range <br /> 1 Clothes washer ; Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) 7— 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 /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be 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 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 Contrr tors L w 18.27 RCW and 296.200 WAC. <br /> c�C /.2/C74 7 <br /> Signature of Owner/Contractor/Authorized Agent Date x <br />