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i <br />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 />PARCEL TAX I.D. # <br />PERI'AIT # <br />/ <br />20r S.E. E E M <br />/ <br />S �Py/' 007 <br />LEGAL LOT NO. <br />BLOCK <br />TRACT Lt {1f�1 E oca o� -a5 5 <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Lop 0 <br />�] <br />Lwk-)-ireS,a'A (t 2.5) lt44 <br />CITYIZIP PHONE <br />CONTRACTOR I ..`bite 5, y 11 ADDRESSc� d <br />U <br />I 1, 1 <br />/0514 Iiw/ Yy D LpnwW d C4)5) 34a— OW <br />CONTR. LICENSE# <br />Wh W899031 <br />USE OF BUILDING <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Electric —Gas. Other I r Y OO . C' 0 <br />WORK DESCRIPTION <br />C_ ttutlN�l QerPer 51�111 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink 6 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />_ <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 />ordinar�,s 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 stale 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 290.200 WAC. <br />Signature of wner/contractor/Authorized Agent Date <br />BIZ <br />