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P�RMIT 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 />SITE ADDRESS <br />PARCEL TAX I.D. # P RMIT # <br />'zSow Wal �{�'� <br />C04-3 16-71 <br />LEGA LOT NO. BLOCK TRACT <br />!! <br />DESC. 7-2 THQ� �U <br />ADDRESS CITYIZIP PHONE <br />O HER n <br />�Gt15CT Cl�fan� �tl� EVrr{4i.trh �f� 5�{ 42 45' <br />ycv'`l`Q� 216L <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />Sc�Un> }iI <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />oWn.xV <br />CONTR. LICENSE K <br />USE OF BUILDING, <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />�L <br />_ Electric _ Gas _ Other <br />WORK DESCRIPTION ��rl <br />l� <br />('00 -CU,ct <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM TYPE OF FIXTURE OR ITEM <br />handling units <br />Toilet <br />Bathtub <br />ir systems <br />rN <br />Lavatory (wash basin) <br />gShower alerKitchen <br />sink & disposal <br />laceDishwasher <br />ryer <br />eClothes <br />washer <br />—Clothes <br />Range hood <br />Water heater <br />Sink (servicelbar/mop/etc.) <br />— <br />Exhaust fan <br />Heal <br />_ <br />Backflow preventer <br />— <br />pump <br />Unit heater <br />_ <br />_ <br />Urinal <br />Drinking Fountain <br />— <br />— <br />Boller <br />Refrigeration <br />— <br />Floor drain <br />— <br />Woodstove <br />Grease trap <br />_ <br />Other <br />Roof drains <br />— <br />_ <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read.and examined this application and know the same to be true and enM. cl. All provisions of laws and <br />herein or not. The of a permit does not presume <br />ordinaces governing thrs type qq�� work will be complied with whether specified granting <br />the of any other state or local law regulating construction or the performance of <br />to give authority to violate or ncel provision f tlra <br />That J am autho zed by the owner of this property to perform the work for which a placation is made and 1 comply <br />construction. <br />State Contra tors aw 18.27 W and 296.200 WAC. <br />Signature of e a or/AuthodZLd Agent rate <br />