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APPLICATIONa*rorevea[iErEnMi*xV�'�-�!�.6��.w�..a�_.i. 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 S <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />MIT f <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY2IP PHONE <br />TENANT ,�A`ME CONTACT FOR PERMIT PHONE <br />�JV <br />E-MAIL <br />�SATRiCi:T AUDRESS CITY/ZIP <br />CONTR. LICENSE # �� C v��rJ <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric Gas Other <br />WORK DESCRIPTION ',40.i� 5� -t'GJ'onf �l'1 cG <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />NC —air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water healer <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (servicelbarlmop/etc.) <br />Exhaust fan <br />6ackflow prevenler <br />Heat pump <br />_ <br />Urinal <br />Unit healer <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodslove <br />_ <br />r <br />Roof drains <br />Other__C tWr SYI�+ <br />Other_ <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby corilily that I have road 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 vio ale or cancel the provision of any other stale or local law regulating construction or the peoormance of <br />construction. That I 1 authorized by e owner of this {Iroperty to perform the work for which application is made and I comply with the <br />State Contractors a' .27 W a f 29fi.200 WAC. <br />Sig r w •rl n ractorl u horized Agent Date <br />