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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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />X95 d3-Da2i <br />80/y► $£V'r yBCvp,7 <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS CITYMP PHONE <br />TENANT NAME <br />CONTACT FOR PERM;T PHONE <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />~'ry IS al0// R/cG I RD. MoNRoE WA 99272 N 360 77* 90/7 <br />CONTR. LICENSE 4 C 425 922 1314 <br />USE OF BUILDING I <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />JiEs/DENT I <br />_ Electric _ Gas _ Other <br />WORK DESCRIPTION <br />-REIo4A7Z- ClDfwy- WA-4w-4 gGAS biMyER <br />- G//AHGL NOT wATFR Pf,4 7-rR <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C -air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Water heater <br />_ <br />Shower <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />�- <br />Gas range <br />Clothes dryer <br />Clothes washer <br />_ <br />Range hood <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />_ <br />Backflaw preventer <br />Heat pump <br />Unit heater <br />_ <br />Urinal <br />Drinking Fountain <br />Boller <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />—Other <br />_ <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerifify 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 />local law regulating construction or the performance of <br />to give authority to violate or cancel the provision of any other state or <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 />3ie oS <br />S gnature o caner/ ontractor/ uthonzed Agent Date <br />