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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 />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />TENANT NIME <br />CONTACT FOR PERMIT PHONE <br />A6�1/t27-1 &d (9-C7 <br />CONTRACTOR Rob;,lelf 14oft'125 LLC ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # Ro&lW H Lgy3 L?- y6oy Fobes Pot 3e?0h0rn&t'1 pS,?Vq CyzS) 3SG- ?o9? <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric Gas _ Other <br />3L�Ji 7�� L �> <br />T <br />c <br />WORK DESCRIPTION New j7„p/eX S9 <br />?q j lC' C?-e <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />& <br />Toilet <br />D <br />A/C — air handling units <br />Li <br />Bathtub <br />_ 2 <br />Forced air systems <br />& <br />Lavatory (wash basin) <br />(9 <br />Gas piping <br />L-1_ <br />Shower <br />oZ <br />Water heater <br />Z <br />Kitchen sink &disposal <br />U <br />Gas fireplace <br />Z <br />Dishwasher <br />D <br />Gas range <br />Z <br />Clothes washer <br />,I <br />Clothes dryer <br />Z <br />Water heater <br />�2 <br />Range hood <br />0 <br />Sink (service/bar/mop/etc.) <br />8 <br />Exhaust fan <br />0 <br />Backflow preventer <br />0 <br />Heat pump <br />0 <br />Urinal <br />n <br />Unit heater <br />6 <br />Drinking Fountain <br />Boiler <br />0 <br />Floor drain <br />.? <br />Refrigeration <br />6 <br />Grease trap <br />D <br />Woodstove <br />0 <br />Roof drains <br />Other <br />0 <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 RRCCW and 296.200 WAC. <br />6—Eo -oG <br />Signature of Owner/Contractor/Authorized Agent Date <br />