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�ERMIT 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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. 9 <br />P T <br />LEGAL LOT NO. <br />BLOCK <br />TRACTOR UBDIVISION p <br />izkiott- .-y l)tt/ !+ y Z S - 2 3 -2- 07' <br />OWNER ADDRESS CITY/ZIP PHONE <br />// <br />/`l r.l� 1 �0 I ( Con 3//�� <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />GZs- z3 z -go7�i <br />UUJ�` E-MAIL �� ii G �9nif/fin <br />CONTRACTOR IllP As IV <br />4 <br />CONTR. LICENSE p <br />USE OF BUILDING �IrILrL�i (�nnl y R�5 <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />n <br />_Electric Gas —Other <br />1�/ <br />WORK DESCRIPTION <br />;NKI?' 99 <br />_5s �37 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />t I <br />Toilet <br />A/C — air handling nits <br />Bathtub <br />Forced air systems <br />/ <br />Lavatory (wash basin) <br />/ <br />Gas piping <br />i <br />Shower <br />% <br />Water heater <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water healer <br />_ <br />Range hood <br />_ <br />_ <br />Sink(service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backilow preventer <br />_ <br />Heat pump - <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />5 <br />Grease trap <br />Woodslove <br />drains <br />Other <br />=Roof <br />Other <br />CITY OF EVERETT LOCAL SALES TAX C4nE IS 3105 <br />j I hereby cerilify that I have read and examined this application and know the same to bet is and correct. All provisions of laws and <br />j ordinates governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />E to give authority to violate or cancel the provision of any other slate or local law regulatirg 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 WAC. <br />Signature of OwnertUontraClorlAUthWrized Agent Date <br />