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PERMIT 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. # <br />PERMIT # <br />LEGAL LOT NO. <br />DESC. <br />BLOCK <br />TRACT _ <br />p 7w 6 14A fZs T <br />OWNER ADDRESS CITY/ZIP PHONE <br />1'r 3q7 73(o0 <br />9'bZOS-1j29 <br />TENANT NAME <br />CONTACT.FOR PERMIT PHONE <br />` oeA 14a c_\� 2 S�_ cl®_ Z q 21 <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />HPmc-14 GeGS, HoMCS 3922 8-74.b A%jiE,NE H2,5=3q'7 73160 <br />CONTR. LICENSE # <br />H i�,,P%ck 9-_T_o 1 gp, r. >- 9!82,O5 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />L E) <br />— Electric Gas — Other <br />D I <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />N� TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub / <br />A/C - air handling units <br />Forced air systems d <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Kitchen sink & disposal <br />Water heater -,,- <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 />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 />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 o ctor 18.27 R W and 2. 0 C. <br />0 <br />Signa ure of a ontractor ed Ag nt Date <br />