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F'CRMIT APPLICATiuN <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 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # /J <br />•�-. l GcJ. iJl HZll�tr O✓L <br />A/ 1�QD <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. S I /0i`;�e.JcL^i. <br />OWNER ADDRESS CITYIZIP PHONE <br />` <br />(�N Ir(��7F�-�f -)(7S/JrF-l�%�S G' <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />L� ijjlil/ �'��/—;5/� �C)• <br />I ,C�iL �- ��ia"iciUc��vl. ° / .7�' ,i-> > = /`� 3 7 <br />CONTRACTOR / n ADDRESS CITYIZIP PHrONE <br />� � J l A <br />�� <br />CONTR. LICENSE <br />� �� <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE 0WORK <br />I — Electric Gas Other <br />WORK DESCRIPTION <br />f-�Ai �✓ f! S%vf� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C —air handling units <br />_ <br />Bathtub <br />_Forced <br />air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />� <br />Wafer heater <br />_ <br />Kitchen sink &disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />� <br />Range hood <br />Sink (service/bar/mop/etc.) <br />A <br />Exhaust tan <br />_ <br />Backllow prevenlor <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodslove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 31e5 <br />I hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinacos governing this type of work will be complied with whether specified herein or not. The granting of a permit dons not presume <br />to give authority to violate or cancel the provision of any other stab 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 Contractors Law 18, 7 RCW and 296.200 WAC. <br />/ <br />aturc of Owne onlraclorlAulhorizod Agent Date <br />