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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.ora � <br />SITE ADDRESS <br />�41� (',� <br />LEGALI LOT NO. I <br />DESC.� <br />OWNER <br />'1%l�.�Y�'��'1' lC�:� <br />TENANT NAME <br />CONTR. LICENSE # <br />USE OF BUILDING <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 P <br />C✓.��� PARCEL TAX I.D. # <br />� LU� � �oi l�Si6$-53a- cx7��r,� <br />BLOCK TRACT OR SUBDIVISION # <br />ADDRESS <br />� y � �i ��G�1 � <br />l��;v / / �� <br />WORK DESCRIPTION <br />V �-��' � a�.9.4 �o u�1 � � 7� <br />PLUMBING <br />� <br />NO. I TYPE OF FIXTURE ORT�M � <br />1 � <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 />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CONTACT FOR PERMIT <br />SOURCE <br />c Gas _ Other <br />s <br />P�„'7' � / <br />od <br />� l;l I T/LIY F'FiUNE <br />�Pi9'� ; L(�G� . Ci �LD % 12.�'Yr%�i�l~33�3 <br />PHONE <br />E-MAIL <br />CONTRACT PRICE OF WORK <br />� � �/ � �� � ��G',1': <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <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 th I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces gover ' g this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authorit o violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. at 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 Contr ctpqs Law 18.27 RCW and 296.200 WAC. <br />! --l(;,—�8 <br />nature of Owner/Contractor/Authorize <br />