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PERMIT APPLICATION <br />' CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - F;�X 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />�/�^ <br />/OZ✓P,f#Ms/� �✓ti <br />a�U$/�-OUY'Dl -O <br />OSG'-f-C(/ <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP 070p <br />////�� y�PHONE <br />.)'fC4o'TcJ'� r�0i-�pRn:fS a/j�/( St./aic.L,StfGtf/XSC �i ill <br />CONTAC/T FOR PERMIT PHONE <br />TENANT NAME�7 <br />% <br />CONTRACTOR AgpRE$5 CITYIZIP PHONE <br />sT,/Su'ih g,.e o yas-sir-rwv <br />CONTR. LICENSE # Be /ky4e/ oA. �R)f <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />_Electric ----Gas _Other <br />I <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C —air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water healer <br />_ <br />Kitchen sink &disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow, prevenler <br />Heal pump <br />_ <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration , <br />_ <br />Grease trap <br />Woodslove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates 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 slate 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 />Slate Contractors Law 18.27 RCW and 296.200'NAO. <br />Signatur f er/Contraclor.'Aulhorized Agent ale <br />