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PcRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICE 0 D <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. # <br />PERMIT # <br />S -3® 2- �v <br />0 <br />LEGAL LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION # <br />DES C. <br />OWNER ADDRESS CITY/ZIP PHONE -3 3 — <br />RC !Z oval° c ti 1'97�3 19S <br />+^ , �°t1r2 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE ,3,, 3- <br />E-MAIL <br />CONTRACTOR m TA ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />ff N \ I 0 0 \ / 'daft-1 <br />_ Electric _ Gas _ Other <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Water heater <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />Other <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 correct. All provisions of laws and <br />ordinaces 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 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 Contractor w 18.77)RWod 29/�'0),W_AI C. <br />`/V �i <br />Signature of Owner/Contr ctor/Aut orized Agent Date <br />2 <br />