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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 />911-113� 7T/✓11a1'-_— j"e- <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />go's— �t0/t//�. ���- //70� /1,1i_.e'/ jyG— , RAj6 e -65Z-7.�i-5/ <br />TENANT NAME <br />I CONTACT F R PERMIT PHONE <br />­23 7e% 36a e- s-2- 7s�7i <br />CONTRACTORR_ ADDRESS CITY/ZIP PHONE <br />1 ry c5: Dle $' <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />'j,A""< <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 />3 <br />Toilet fit <br />A/C —air handling units <br />f <br />�i <br />Bathtub i I <br />Lavatory (wash basin) 1 111 I I <br />Forced air systems <br />Gas piping <br />I <br />Shower <br />1 <br />Water heater <br />I <br />Kitchen sink & disposal <br />Gas fireplace <br />! <br />Dishwasher <br />Gas range <br />0 <br />Clothes washer <br />I <br />Clothes dryer <br />Water heater <br />I <br />Range hood <br />Sink (service/bar/mop/etc.) <br />J4 <br />Exhaust fan I I I V �/ <br />Backflow preventer <br />Heat pump I ( f <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 Contractors LawA.27 RCW and 296.200 WAC. <br />j ALe'4�j�X4_ <br />ZOwn <br />Signa"tur o er/Contractor/Authorized Agent 'Date' <br />