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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 />SITE ADDRESS ` �) <br />' <br />PARCEL TAX I.D. # <br />PERMIT # <br />PI —oo-� <br />) ( <br />✓ <br />06t <br />LEGA LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />1e ll I�� 9�,+0�� )s <br />I <br />TENANT NAME <br />CONTACT FOR PER�MIT/ PHONE -�--�/ <br />q I <br />A,,)/'11- Cl) 3 11 ^r A <br />tidy E-MAIL /V <br />�r��- A E i7r 5, 1¢Pl✓Q Cl�7/ E �30(v,. <br />CONTR�CTayol u- ./r�s <br />/•—,�R� <br />CONTR. LICENSE #,' <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />_ Electric _ Gas _ Other <br />WORK DESCRIPTION <br />JJ JJ <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM 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 />Lavatory (wash basin) <br />__ <br />Gas piping <br />_ <br />Shower <br />Water healer <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow prevenler <br />_ <br />Heat pump <br />_ <br />Urinal <br />_ <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodstove <br />_ <br />Roof drains <br />_ <br />Other <br />Other <br />— <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 proysion of any other stale or local law regulating construction or the performance of <br />constructioo,That I am authorized by ttt owne of this property to perform the work for which application is made and I comply with the <br />State C nGacl is Law 18.27 RCW and 2 60 WAC. <br />%% -10 <br />Sighattrre of Owner/ConlraMurtXuthorized Agent Dale <br />