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OtiRMIT APPLICATI6N <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 d 5 - 6) <br />SITE ADDRESS PARCEL TAX I.D. rf P�7 �t b� ' <br />C f44 ✓ 228 0 <br />LEGA LOT NO. BLOCK TRACT OR SUBDIVISION # <br />r <br />OESC. 22 R Z6 — D sJ <br />ADDRESS CITYIZIP PHONE <br />OWNER <br />�obSany �a�ik`i <br />- <br />TENANT NAME CONT CT FOR PERMIT G „ ^ (�kPH � E <br />A�NM / ��rk w11 Frr (jfan}ccts <br />'Pn- q tiAl 9 i7r7 1 EM IL <br />-CONTRACTOR� <br />CONTR. LICENSE # A x <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />� G` L v I _Electric X Gas Other <br />WORK DESCRIPTION { / / A( <br />I S` �L� Cl �oC�✓f �� <br />L'anStruc� N ��• _ <br />It 'TRVJ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />---------------- <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Water healer <br />_ <br />Shower <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />_ <br />Dishwasher <br />Gas range <br />Clothes dryer <br />_ <br />Clothes washer <br />Range hood <br />_ <br />Water healer <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />_ <br />Backflow prevenler <br />_ <br />Heat pump <br />Unit heater <br />_ <br />_ <br />Urinal <br />Drinking Fountain <br />_ <br />_ <br />Boiler <br />Refrigeration <br />_ <br />Floor drain <br />Grease trap <br />_ <br />ove <br />_ <br />Roof drains <br />_Other <br />Other <br />— <br />Other <br />=I <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 />of any other slate or local law regulating construction or the performance of <br />to give authority to violate or cancel the provision <br />construction. That I am authori ed by the owner of this property to perform the work for which application is made and I comply with the <br />Stale Contractors L w 1 .27 CW and 296.200 WAC. <br />(J 6r d 111 <br />1 <br />Signature of Own er/Conl actor/Authorized Agent Date �^ <br />