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PERMIT. APP:LICATION <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 />5 <br />62U 3 902 3 <br />LEGA LOT NO. BLOCK ,TRACT <br />/,C <br />c,L 4l / /9 © 7 �j/V �� /V GO1161� o <br />OWNER ADDRESS CITYIZIP PHONE <br />�•r�er,`c� CGSa.,-/ems s,PV NF ��t,� c� ZI J- e cs 9 zS <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />frees Z-/.s-7� <br />CONTRACTOR ADDRESS v CITY/ZIP PHONE <br />F/-'dell-lc <br />C!� ��/Y s ��, s��n�, E'2 l Sid 5 All <br />CONTR. LICENSE # <br />/ --�/ GGC sOQ <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric _ Gas _ Other <br />/00' Ge,70 <br />WORK DESCRIPTION <br />: 1301273. <br />�� <br />PLUMBING <br />MECHANICAL <br />No. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />3 <br />Toilet <br />A/C —air handling units <br />.2 <br />_3 <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Forced air systems <br />Gas piping /- <br />Water heater <br />Kitchen sink &disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_L <br />Clothes washer <br />�_ <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 />_ <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 Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />