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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES 2 <br />3200 CEDAR STREET, EVERETT, WA 98201 p . p <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org/�lGO <br />i V <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />I PARCEL TAX I.D. # <br />PERMIT # <br />LEGALI LOT NO. <br />DESC.f !� <br />BL60CK�TRACT <br />00C D -cJ <br />OR SUBDIVISION # <br />OWNER ADDRESS CITY/ZIP PHONE <br />Ci!,� CG Es yN;;� S9Iy FcE; 4.IdC .5% yY--ZO.3 7 l <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />E-MAIL <br />Nd6 7RgC7(JR ADDRESS ITYI I PHONE: <br />CONTR. LICENSE # 7 <br />L <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric _ Gas _ Other <br />37/ <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO.. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />/ <br />Toilet <br />__ <br />A C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water healer n <br />+! <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water healer <br />_ <br />Range hood <br />Sink(service/bar/mopletc.) <br />�—�— <br />Exhaust fan <br />Backllow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />_ <br />Woodstove <br />_ <br />_ <br />Roof drains <br />_ <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 a authorize by the owner of this property to perform the work for which application is made and I comply with the <br />State�Fetors L 18.27 R W and 296.200 WAC. 7 (J <br />Signature of Owner!Coplr clor Authorized Agent Date <br />