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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 />PO -/®L,/ Q <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />\le-. <br />O\O <br />•O <br />'lo Li <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />`FCC _ <br />OWNER <br />Le�ac�lr�or�e��W • 1 ISIIo <br />ADDRESS <br />LJR .S\.e' e <br />CITY/ZIP <br />L1R.Steve�ns <br />PHONE •33y <br />�� <br />zoo <br />`ff6 Z.6a <br />05'3 <br />TENANT NAME I <br />CONTACT FOR PERMIT <br />PHONE <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />LCC-, AC �la�lUR� <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />SC-- ? <br />WORK DESCRIPTION <br />rAevJ <br />a9\9'A-GG10\e- <br />PLUMBING <br />Electric Gas _Other <br />�tK�e aka <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other_ <br />MEC <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <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 Contrtor�ayu 18.27 RCW and 296.200 WAC. i <br />