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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 />APPLICATION'S ARE ACCEPTED FROM B AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # PEI;"/IITTi# <br />e�C�?�Bdufi ���4✓ �Y� J <br />__ <br />LEGAL LOT NO. <br />BLO <br />TRACT 2 9r0.51 �W YoIWV <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />_ 7 :>+ 1 I t512t.-tA S 7 <br />o-lTg7 0 SZo too <br />V-E� W G'&-17 1`4 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Vat94 ZoN <br />I C�1Zl�s ee:_-_ 4ZS-tcc3-ItartG <br />CONTRACTOR 1 i. I��� Z_S_7S CITYIZIP PHONE <br />42S-Z�f4 -4c�`o <br />'> - <br />CONTR. LICENSE # <br />SD9E� 101 1; 1'F <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric Gas —Other <br />�/y <br />WORK DESCRIPTION d <br />PLUMB114G <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />AtC— airhandlingunits <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />— <br />Gas piping <br />_ <br />Shower <br />_ <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />— <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 />_ <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 />Hoofdrains <br />_ <br />Other <br />_ <br />— <br />Other <br />I — <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify 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 />Stale Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />nFA <br />