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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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />1.2 4-L l <br />PARCEL TAX I.D. # <br />PERMIT # <br />. i[ 0 f-f <br />50-)OI --a0Z <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />F ;l_E ,11- 41/c- t t_'[4 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />/ <br />E t4ey� 7���( <br />I T[W] tti(ILiR(/j <br />CONTRACTOR ADDRESS CITT2IP PHONE /1 <br />-njl �40 �izc�ol�/ ��'/S a""��� ht�ki-e kQ <br />CONTR. LICENSE # $22212rJc) <br />USE O UILDING JI <br />HEAT SOURCE <br />CONTRACT PRICE OWORK <br />(//�� )'t <br />I <br />— Electric Gas Other <br />, v <br />I / <br />WORK DESCRIPTION l-t el()S�K . jq�N S �J EQf� - �L�p� �J <br />lNew <br />rt4tlu��-f - �fJ$*Ll-� <br />e")'y F�57 "t-L"-e/ . <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR REM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />WC— air handling units <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />Gas (replace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit healer <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />-- <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby Certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinptes governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to giv authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />con ruction. That 1 am authorized by the owner of this property to perform th work f r which application is made and I comply with the <br />Stalb 910ntraclors L 8.27 RCW and 296.200 WAC. <br />Si at e o n / clor/A orrzed Agent Datp <br />