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PLRMIT APPLICATIGN <br />I <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 <br />PARCEL TAX I.D. # <br />PERMIT # <br />1A50 -/ <br />LEGA LOT NO. <br />OCK <br />TRACT <br />DESC. <br />NER ADDRESS CITY/ZIP PHONE <br />�l�i i`rL /U lam,% �1,1,C� •,- �S `�GX>/ �=yrrG/'r�N L✓�+yGih�rP� `%�s%`l�� <br />ZNANTNAME r <br />CONTACT FO E MlT PHONE <br />���s��� <br />G;� n�� �.��<%fig=�a�,� <br />CONTRACTgR I ADDRESS CITY/ZIP PHONE <br />�,�/3/t ✓�r�rr s,� ���r� sist`-•��I�I/le <br />1�+� 1/ �^ <br />CONTR. LICENSE # J"e}C;-C7�i- <br />CfW'I AJOL, <br />USE OF BUILDING <br />HEAT SOURC <br />CONTRACT PRICE OF WORK <br />I — Electric Gas Other�ev <br />-- <br />I <br />WORK DESCRIPTION <br />I <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 />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backfiow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />C (K' <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />=I <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 />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 state or local law regulating construction or the performance of <br />construction. That I am authop2e y the owner of this property to perform the work for which application is made and I comply with the <br />State n FI( 18.2 and 296.200 WAC. <br />/ j 7- <br />Si ature of ner/Contrac or/Authorized Agent Date <br />