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PLRMIT APPLICATI&N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org —7 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 3 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. i <br />P 17 <br />5106 F(�,u Sf' 14, W►4 <br />�i <br />LEGALL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY0P PHONE <br />1-4c.9rektcz 04'a4:/kc -p'Atj Skb-5;azrt►K <br />TENANT NAME <br />I CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE N <br />6cJ/u/2J <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />} <br />P� Sw�aa i y� to <br />I — Electric Gas -L Other <br />I <br />Ai (�D <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Z <br />Toilet <br />A/C - air handling units <br />I <br />Bathtub <br />1 <br />Forced air systems <br />R <br />Lavatory (wash basin) <br />Gas piping <br />1 <br />Shower <br />_� <br />Water heater <br />I <br />Kitchen sink & disposal <br />Gas fireplace <br />J <br />Dishwasher <br />Gas range <br />I <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />Range hood <br />Sink(service/bar/mop/etc.) <br />Exhaustf?n <br />_ <br />Backfiow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit healer <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify 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 />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of uwnek—ontractor/Authorized Agent Date <br />