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PERMIT APPLICATIVN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 -FAX 425-257-8857 - vvww.evereltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br />SITE ADDRESS � PARCEL TAX I.D. # � PERMIT # <br />NQ soeiot-1-OI.C7 <br />3 <br />LEGAL LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION p <br />I <br />DESC. <br />OWNER ADDRESS CITY2IP PHONE( yv <br />MNU,Tw nr. N:C Ma,vu-'4e, wA.�r✓��I <br />NAME CONTACT FOR PERMIT PHONE <br />(TENANT <br />{� � E-MAIL <br />—q�ADDRESS I /ZIP H E <br />AD oNC— caFP <br />CONTR. LICENSE # <br />�poNC—oC ��3t PIS C�-S3i L�-�---� (3h <br />USE OF BUILDING <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />t N <br />y� <br />Electric Gas Other �—b-oq <br />WORK DESCRIPTION "C`I,, I 6`l�¢.� S s,� � �I V� � C=�C�-lV't"e �.�}C✓� <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 />_ <br />Bathtub <br />_Forced <br />air systems <br />_ <br />Lavatory (wash basin) <br />_Gas <br />piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink &disposal <br />_Gas <br />fireplace <br />_ <br />_ <br />Dishwasher <br />Clothes washer <br />Gas range <br />Clothes dryer <br />_ <br />_ <br />Water heater <br />Sink (service/bar/mop/etc.) <br />_Exhaust <br />Range hood <br />fan <br />_ <br />_ <br />Backgow prevenler <br />—_ <br />Heat pump <br />heater <br />Urinal <br />Drinking Fountain <br />_Unit <br />_Boiler <br />Floor drain <br />_Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />_Other <br />_ <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify 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 violate or cancel the provision of any other state or local law regulating construction or th.) performance of <br />this to the work for which application is made and I comply with the <br />construction. ThatI am aul rized by the owner of property perform <br />Slate Conlracto Lac .27 RCW and 296.200 WAC. <br />'(7/ <br />SignalutO of ner/Contractor/Authorized Agent Date <br />