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PIRMIT APPLICATIU' N <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 PM 01 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY1ZIP PHONE <br /> .E'rl e x e71- rSchrzP/ 9is7- w,.;7- <br /> TENANT <br /> rd2TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTO.'< Vcti4weirl Aee[ 1KN1C41 ADDRESS Ro. I—X//9.77 CITY/ZIP PHONEBb6-���cQ9. <br /> CONTR.LICENSE a V 4U WE M <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> N Q J S SRC /h Electric _Gas_Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> L Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> y3_ Sink(service/bar/mop/etc.) _ Exhaust fan <br /> _ Backflow preventer _ Heat pump <br /> Urinal _ Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> _ Grease trap Woodslove <br /> _ Roof drains 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 /> 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 cons'iuction 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 18.27 RCW and 296.200 WAC. <br /> t-13 ,07 <br /> Sighaturo of Owner/ ontraclor/Authorized Agent Dale <br />