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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 TAX I.D. # PERMIT # <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />OWNER <br />ADDRESS <br />CITY/ZIP <br />PHONE <br />'R os& i4oMC-5S <br />//f-r- <br />%l n4 A(A•e-fJ%VG- ,7%/2i <br />9FJ-7 1 <br />lr &/*•yufil/E <br />4d <br />TENANT NAME <br />CONTACT F R PERMIT C W-LU a/t° <br />PHONE <br />�i�y �rrc s VZt-- ga-"- azoq <br />4/Z1; - 32,7- .23 7y <br />36v nr- s'2- 7_'S�i <br />CONTRACTOR <br />It-e- <br />ADDRESS <br />1/7D (o <br />CITY/ZIP <br />PHONE <br />)e0*,e__- <br />CONTR. LICENSE # <br />e,6#Z <br />O ey,1U <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />—Electric �/ Gas _ Other <br />WORK DESCRIPTION <br />( -a <br />NO. I TYPE OF FIXTURE OR ITEM <br />3 <br />Toilet 11I <br />Bathtub 11 <br />Lavatory (wash basin) 111 b <br />Shower i <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />tr <br />1 <br />1 <br />i <br />a <br />NO. I TYPE OF FIXTURE OR ITEM <br />r <br />A/C -air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <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 Law 1Z.27 RCW and 296.200 WAC. <br />