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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 QG�DO�i <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />� " - 1 ( <br />h7-'5f:N h�UU G�f 'Ml%. CCecc`tV <br />-Z co-Z e'q -I cjS- Mot <br />0t7 <br />LEGAL LOT NO. <br />DESC. <br />BLOCK <br />TRACT OR SUBDIVISION # t <br />`aa:_ Cij, ('.CV k" t.\ V•v SG(106'00 <br />OWNER ADDRESS CITY/ZIP PHONE <br />a 5-5e, c,4e-e�� \A/A <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE+7C —59 O13'7 <br />l_ ,I <br />E 4e c'_1i vx'\ek.10 A I � 1y • <br />I �{I V� U L7\Gl� E-MAIL 4 Yi'A& C-4(t'tR 61A i - <br />_CdNT GT Sb 1T' r <br />MTA (mr�t'cuci�o�'1 �• 0 • I rc?'(o <br />. ` y� 1�1 <br />CONTR. LICENSE # A,11^ C _ O I —150-' N 11 <br />R <br />USE` OF 9UILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />04-ire T-aA'er <br />X Electric Gas Other <br />2_; r I bC <br />WORK DESCRIPTION r <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <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 />— <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />Water heater i l <br />_ <br />Range hood <br />Sink (service/bar/mop/etc.) Q <br />Backflow preventer S <br />_ <br />Exhaust fan <br />Heat pump <br />Urinal <br />Urinal <br />Drinking Fountain <br />Unit healer <br />Boiler <br />— <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 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 />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 state or local law regulating construction or the performance of <br />construction. T at I anaulhonzed by the owner of this property to perform the work for which application is made and I comply with the <br />State Contras rs a 182ZRCW nand 296.200 WAC. <br />\ <br />V <br />Signature of O ner/Co 7onzed Agent Date <br />DWI <br />