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PCRMIT 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 1=�C��Ci' ti"t l"r PARCEL iAX LD. # PERMIT # <br />Wv6 <br />1 ,C)3 V cu, Yv1 LtO/ wLA? <br />LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />TENANT `r"'U CONTACTFORPER IT PHOfIIE 2U6 <br />NAMEQ <br />E-MAIL <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />erw`( U -too <br />CONTR. LICENSE# �2GV'A/ N CD / ��'f •�/ '71 (Crf �C)� <br />�-7.7 / <br />�- <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Ze <br />I _Electric — Gas _Other <br />% <br />WORK DESCRIPTION ` <br />SrftN <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />— <br />A/C — airhandlinguoits <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />— <br />Lavatory (wash basin) <br />— <br />Gas piping <br />Water heater <br />_ <br />Shower <br />Kitchen sink 8 disposal <br />— <br />— <br />Gas fireplace <br />_ <br />_ <br />Dishwasher <br />_ <br />Gas range <br />Clothes dryer <br />_ <br />Clothes washer <br />— <br />Range hood <br />_ <br />Water heater <br />Sink (service/bar/mop/etc.) <br />_ <br />_ <br />Exhaust fan <br />_ <br />_ <br />Backflow preventer <br />— <br />Heal pump <br />Unit heater <br />Urinal <br />Drinking Fountain <br />_ <br />_ <br />Boiler <br />— <br />Floor drain <br />— <br />Refrigeration <br />_ <br />Grease trap <br />— <br />Woodstove <br />_ <br />Roof drains <br />Other <br />_ <br />Other <br />— <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 a onzed by the owner of this properly to perform the work for which application is made and I comply with the <br />Stale Contractors w 8 7 RCW and 296.200 WAC. <br />S z <br />Signature1 Owner/Co raclnr/Authorized Agent Date <br />Z <br />