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P MIT APPLICATI� <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 />L''(; j�" l��:. <br />11 �.. 1 �' _� ._ i`��. <br />LEGAL LOT NO. BLOCK <br />DESC. <br />OWNER <br />_,_ �_ , . � <br />._ �\. __ , � l � � � . �- <br />TENANT NAME <br />PARCEL TAX I.D. # <br />c_`� S�� � ���' ��C��� (` <br />TRACT OR SUBDIVISION # <br />ADDRESS <br />_ ,,• <br />' `� l �.� ; -� i .' � ( � j ;� ` �� l% �'. <br />I CONTACT FOR PERMIT <br />� r, � E. <br />CITY/ZIP P <br />T��.�' - - _ __`. ; <br />PHONE <br />PERMIT # <br />Zi ���� _-��.� <br />NE <br />� E-MAIL <br />CONTRACTOR . . , , __ ADDRESS CITYIZIP PHONE _ - <br />--x �- �t � �� T � i ,_ �'��. i +.i . � w - ` _ V , _ • _ -� �-� <br />, _- � - �-' � l `. �,.'' _� — � �, t �._ . --';? `_,._� � _ i J <br />CONTR. LICENSE # <br />USE OF BUILDING <br />_.,�: -. - , ��-_ ; <br />HEAT SOURCE _ � CONTRACT PRICE OF WORK <br />Electric Gas Other /" � � '�''� " <br />WORK DESCRIPTION <br />, - .: _ _ <br />- � y , � ,- , . . � - <br />._.._> t _. ,_ - . , , i _ _ , . <br />NO <br />PLUMBING <br />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 />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO <br />MECHANICAL <br />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 certify that I have read and examined this application and know the same to be true and correct. Ail provisions of laws and <br />ordinances governing this type of work will be comptied 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 compiy with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />. , <br />/ _ ? f ' 3 ' _ _� �t_ , _ , , ' _� <br />S gnature of OwnerlContractor/Authorized Agent Date <br />/ ,' <br />