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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 �_ _ <br />PARCEL TAX I.D. # <br />P RMIT # <br />�— . <br />12 <br />as 0 20 <br />LEGAL LOT NO. <br />DESC. <br />BLOCK <br />TRAC !�. <br />OWNER ADDRES CITY/ZIP PHONE <br />C _ <br />/�A <br />TC <br />`j/- v mJ <br />'TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />I 'A'Kh 03-11 <br />1 49 70 <br />CONTRACTOR! tEe5�. &;'C�95 J-0., ADDRESS �Q CITY/ZIP PHONE �//p� 7` c/�i /�/ <br />CON7R. L1ENS�# �' -�' ... ' �, ..yes4'16ZjA_�"— r t r <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric Gas _ Other <br />WORK DESCRIPTION <br />� l C�' <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE -OR ITEM <br />Toilet tJ <br />A/C — air handling units <br />Bathtub / <br />I <br />Forced air systems <br />Lavatory (wash basin) ,/�/ <br />J� <br />Gas piping <br />Shower / <br />_� <br />Water heater <br />! <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />_� <br />Clothes dryer <br />Water heater <br />_� <br />Range hood <br />Sink (service/bar/mop/etc.) <br />! <br />Exhaust fan <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <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 />ordinaces governing th' type ofVlied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to e o ancelf any other state or local law regulating construction or the performance of <br />construction. Tha authoriz b this property to perform the work for which application is made and I comply with the <br />State Contra s L 18.27 R W AC. <br />Signature of er/Contra orized Agent D e <br />