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FtcRMIT APPLICATIuN <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 �!'(� (� Ftrcj",LAJ(. PARCEL TAX I.D. # PERMIT # <br />rcl,� �� o0 393 z coo � � IL- o l jiG50<v-cl� <br />LEGA LOT NO. BLOCK TRACT <br />DESC <br />OWNER SF�AQ.GN yy1 ADDRESS p- �. L CITY/ZIP PHONE <br />(y�W W-QF-K-% Ir✓IN�' LIU Tcw I L�f�. 4� 2% S' ��>�'S� ZSZ -�/5 ,_ �. <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />CONTRACTOR <br />ADDRESS <br />CONTR. LICENSE p Z22 / <br />USE OF BUILDING HEAT SOURCE <br />Electric Gas Other <br />WORK DESCRIPTION <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM NO. <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinkinn Fountain <br />Floor drain <br />Grease !rap <br />Roof drains <br />Other <br />CITY/ZIP PHONE <br />CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 />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 viola:a 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 owW of t ' operty to perform the work for which application is made and I comply with the <br />State Contractors Law .20 QC. <br />