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z <br />L <br />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 LD: # PERMIT # <br />LOT NO. BLOCK TRACT OR SUBDMSION # <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />1_ k!A a l) IJ1 -'� f?i St, ti i `> i i 5 S rH a1_ A r1 t C vc� <br />v "1CiC�S <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />E-MAIL., <br />—ADDRESS CITYrzir <br />P'AVrt�;i ACTOR <br />{t1t�1�S CLlti i lSi� tJ 5��� �7 .�,Tt"C t✓. ?.0 k� J 1Cs 2C-i4 <br />CONTR. LICENSE# �1- iO <br />3 <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />_ _ Electric ^ Gas _ Other <br />WORK DESCRIPTION <br />C�f4�2A4E � GJ F• <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM 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 />Water heater <br />Sink (service/bar/mop/etc.) <br />BackBow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />A/C — air handling units <br />Forced air systems <br />Gas piping [ oS <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 />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 />ordinates 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,aw 1827 RCd 296.200 WAC. <br />