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PERMIT APPLICAT N <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 /> fAPPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM e3 ._aV `( <br /> SITE ADDRESS .1fL PARCEL TAX I.D.# PERMITF V " U <br /> /b 3 ? 114564.Itall4 dae .) <br /> ("__ 0&)6/ ' C)-4 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> Vm42hsi 7,J75.)- 5-Iyeruoi v , 71a0 Ls6�3/I <br /> TENANT NAME CONTACT FOR PERMIT PHONE aa SCP gd13 <br /> t";t Cjh1E-MAILC�V'Ct�' 6141'5C"�lSD1'zS <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE, s, ft ei- <br /> CONTR.LICENSE# [�',`/y}�j� <br /> USE OF BU DING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric )Q Gas Other <br /> WORK DESCRIPTION Ietrii) 4- n/et--e-e_ OM ith li11w ee 4eu,¢.ers <br /> PLUMBING MECHANICAL <br /> NO. <br /> � TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> / I//Toilet A/C—air handling units <br /> athtub Forced air systems <br /> / Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> t to"--Clothes washer /X 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 /> 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 auth. ' t : . n- of this property to perfo m the work for which application is made and I comply with the <br /> State C,Cmtra.tq�s L w 1' d 296.2 . WAC. <br /> Signature of Owner .00.:/Authorized Agent Dat <br />