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PLRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.e\terettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT $ CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # <br />y-w PERMIT# <br />( /Loss A✓r 2009OJ0 Ou-.t-4 J C/l�- I <br />LOT NO. I BLOCK I TRACT <br />DESC. <br />S17n 6d/PO,�lr,o/� /1Lt4's E to Sr 'yzv �a�ca� vrr�t✓19F,0'y c/zj = e/wb <br />TENANTNAME CONTACT FOR PERMIT <br />PHONE <br />/Vy/zj6Z A, u—eS. '.oar I LLc I %' C-/Ii;�-� (,LCiE (3('' )) S63 <br />b c� <br />CONTRACTOR <br />/'r ,I ADDRESS CITy/zlP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING HEAT SOURCE //( CONTRACT PRICE OF WORK <br />Electric _ Gas _ Other <br />WORK DESCRIPTION <br />PLUMBING MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br />_ Toilet <br />_ Bathtub <br />_ Lavatory (wash basin) <br />_ Shower <br />_ Kitchen sink 8 disposal <br />_ Dishwasher <br />_ Clothes washer <br />_ Laundry tray <br />_ Sink (service/bar/mop/etc.) <br />_ BackBow prevenler <br />_ Urinal <br />_ Drinking Fountain <br />_ Floe drain <br />_ Grease trap <br />_ Roof drains <br />Other <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby c:,ritify 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 c;mplied with whether specified herein or not. The granting of a permit does not presume <br />to give autttodty to violate or cancel the provision of any other state 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 Contr ctors L 18.27 and 296.200 WAC. <br />i /?z 9� <br />Signature of Own rlContractor/Authonzea Agent Date <br />