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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITEDDRgS <br />P CEL TAX I.D. N <br />ERMIT O <br />i% <br />-o� <br />fEGAq LOT NOBLOCK TRACT OR SUBDIVISION N <br />j DESC. lq—i' <br />OWNERI AD{,DyRE/ASS-yam/ CITY2IP PHONE <br />TENANT NAME <br />CONTACT FOR PE IT PHONE #0,5 s.%,A'L 1147 59 <br />I E-MAIL <br />�CONTRACTOR GITYIZIF PHONE <br />w Ai49� <br />CONTR. LICENSE N <br />USE OF BUILDING <br />HEAT SOURCE <br />I „ CONTRACT PRICE OF WORK <br />C-�It Y✓� <br />I — Electric Gas Other <br />j WORK D S� ION <br />1g�X 32� �rr lfccl.z�> <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />S <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />I <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />3 <br />Gas range <br />=Kitchen <br />Clothes washer <br />411 <br />Clothes dryer <br />y <br />Water heater <br />_-0 <br />Range hood <br />G <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />Roof drains <br />_Other <br />I <br />Other <br />!I <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 />ordinances 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 pe rm the work for which application is made and I comply with the <br />State ctors Law 1 27 RCW and 296.200 WAC. <br />Co� <br />l 1/D <br />j <br />ig <br />Signat re of ner/Contractor/ thorized Agent Date � I <br />