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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 r <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 41PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />LEGAL LOT NO. I <br />BLOCK I TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />W mil` /IV �Pi' // ��FiO� �LL/`�i/G'r®/i �d°✓%�i y�l/� , i . Q r �� ��+ �'vlG/ fP-�Ji—`1`�ni <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />CONTRACTOR s ffj E. ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />C_ <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />r <br />Electric Gas _ Other <br />V <br />WORK DESCRIPTION <br />C!:q 291i7i <br />PLUMBING -MECHANICAL <br />NO. TYPE OF FIXTURE"OR ITEM f " NO: TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry fftySJol` <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 />'�- <br />—L <br />/ <br />I W <br />I <br />f Q* <br />— <br />-- <br />'- <br />A/C _T 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 />_ <br />/ <br />/ <br />1AW <br />— <br />-- <br />-- <br />-' <br />— <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 18.27 RCW and 296.200 WAC. / / <br />c - I1 C �' vL&S,- <br />