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Ed <br />l <br />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 Q -03 Z <br />,APPLICATIOVS ARE ACCEPTED FROM R AM TO 4 PM <br />SITE ADDRESS E; <br />PARCEL TAX I.D. 0 <br />F)`ERIrIIT f <br />LEGAL LOTNO. <br />BLOCK <br />TRACT <br />DES <br />OWNER ADDRESS CITYZP PHONE •zp —� <br />�y J,k (S100 Lyr1e1LkPo4,W4130i_� <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />/ <br />J1L � '2f.Qwt Swr-o Sk�l0 <br />l\✓i uh71 7A4/3I b-0/ <br />7 2 <br />CONTRACTOR ADDRESS CITYZP PHONE <br />CONTR. LICENSE NJ <br />�2.JLJ <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric —Gas _ Other <br />7 00 <br />WORK DESCRIPTION <br />T' S:,Je'SS}YUClLr�1 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C — airhandlingunits <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink(service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodstove <br />_ <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 />Dat <br />e oOwner/ContractorAuthorized Agent Signaut� <br />2 <br />%2 / <br />