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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,PARCEL <br />TAX I.D. # <br />PERMIT # <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />a I I I L. aa u, S %-I �- S' R 3- j P Y <br />n a- 5 <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />L . (Z . C.OviST44Cr10M 5 CatoLegS LL�L f rn & ySo(p L(2.5'a`13 -5KS <br />CONTR. LICENSE # a, s a- 5 a en A,o w 4 `( <br />t_ a el oMC.C, a15 Z PG 10 -7-1997 Cy4.04 tr— r R P 9 Si ,�_O 1: <br />USE OF BUILDING <br />HEAT SOUR E <br />CONTRACT PRICE OF WORK <br />Electric Gas Other . <br />WORK DESCRIPTION 3u4 L. a A ro �w S.� �. rh g 114 11 2_4 A Q 5o 147 <br />i.tppt.� tZyy `t' <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITgM <br />,3 . <br />Toilet <br />A/C - air handling units <br />0- <br />Bathtub-' <br />Forced airsystems— <br />Lavatory (wash basin) <br />7 <br />Gas piping <br />_L <br />Shower ,r <br />_� <br />Water heater i <br />_L <br />Kitchen sink & disposal ✓ <br />Gas fireplace — <br />I <br />Dishwasher , <br />Gas ranges-- <br />Clothes washer <br />Clothes dryer;, <br />Water heaters. <br />_� <br />Range hood <br />—I <br />Sink (service&dmop/etc.) <br />Exhaust fang )j l <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 C ntractors Law 18.27 RCW and 296.200 WAC. <br />to <br />Signature of wner/C ntractor/Authorized Agent IDate <br />