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PL IMIT APPLICAT164 <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 n / <br />425-257-8810— FAX 425-257-8857—wwv.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 />005 oD000 FOO �JV 0( <br />LEGA LOT NO. LOCK TRACT <br />DESC. r <br />(' 12mIL -oly -ay <br />ArL.L nan Horne SIn. )01QI60(l!C(jr 111r Ftrrrtf 93.joy #78 <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />ArEi.50.n iio.r,eS L,�• lolal E'cerc�rcei 1 Cv� �v(�xe (g��pr1 �Ol� Y7s'• G 9�/7 <br />CONTR. LICENSE # <br />ARTZSN'LA�5C3 <br />U;SSE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />- I� S lA en :( Ll <br />_ Electric -X_ Gas _ Other <br />I <br />I <br />WORK DESCRIPTION �1jri �� �tj�;,`; <br />)t;�� ;< .# l;;rl <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 />:r Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />T <br />Gas piping <br />Shower <br />% Kitchen sink & disposal <br />Water heater <br />_; Gas fireplace <br />Dishwasher <br />range <br />Clothes washer <br />_Gas <br />Clothes dryer <br />_ Laundry tray <br />/ Range hood <br />_ Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ Dackflow preventer <br />pump <br />_ Urinal <br />_Heat <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 <br />application and know the same to be true and correct. All p•ovisions of laws and <br />ordinates governing this type of work will be complied <br />with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision <br />of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the ownerof this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 ROW and 296.200 WAC. <br />Signature of Owner/COntractor/Authonzed Agent <br />Date �/� <br />