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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 />P IT <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC.r See Akio► Ci'1 <br />O ER ADDRESS CITY/ZIP PHONE H 25 33 . QS <br />'fond t�1lo S L� +e�r✓Y1S C M. <br />LLdcns <br />�' of 5-w_ve,,51y A <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />� it -►�� <br />I Ga r (� 4- 1 <br />CONTRACTOR ADDRESS CIITYYIZIP PHONE <br />CONTR. LICENSE # <br />1� <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />Elect ' Other <br />WORK DESCRIPTION <br />I�IOgI pu P e_)4 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />W <br />Toilet fitA/C <br />—air handling units <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) ) / I I <br />10W <br />Gas piping <br />Shower j <br />Water heater <br />Kitchen sink & disposal <br />A_ <br />Gas fireplace / <br />Dishwasher <br />�_ <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />Range hood <br />I <br />Sink (service/bar/mop/etc.) <br />10_V <br />Exhaust fan <br />Backfiow 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 autho ' I by the owner of this.property to perform the work for which application is made and I comply with the <br />Staff Contracto Law, . 7 RC Viand 6.200 WAC. <br />��� /�L1016P <br />SilFhftre of Owner/ r/Authorized Age t Date <br />4357 AW 611oo� <br />