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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 />BOCK <br />TR T <br />DESC. � <br />OWNER ADDRESS CITY/ZIP PHONE <br />- , uSa.. yes --►y 3 ��� <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />--. <br />( �- e sl y - - _ <br />y �,. s �, �5 � l3 11' I g <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />(-I 0-3a LAaL-s ''i<l3 Clt� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />S % 'C\ v °r c� rv.. � �4.ua c�R�' <br />Electric L,Gas Other <br />1 <br />— — <br />WORK DESCRIPTION )I ,7 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet �k\ <br />A/C — air handling units <br />5 <br />Bathtub \o, <br />Forced air systems <br />iA <br />Lavatory (wash basin) <br />—L_ <br />Gas piping <br />Shower <br />Water heater <br />I <br />Kitchen sink & disposal <br />j <br />Gas fireplace <br />I <br />Dishwasher <br />_� <br />Gas range <br />t <br />Clothes washer <br />Clothes dryer <br />� <br />Water heater <br />_� <br />t <br />Range hood/ V1if2c o <br />Sink (service/bar/mop/etc.) <br />_ S <br />Exhaust fan <br />Backflow preventer <br />Heat pump <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 />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 RCW and 296.200 WAC. <br />I 0 0,3 <br />SignatuM of Owner/Contractor Authorized Agent Date <br />