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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 />PARCEL TAX I.D. # <br />PERMIT# <br />0 — <br />n— bOS <br />LEGAq LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY141F PHONE <br />S;Pcac'a« EVe ?PA YY M 1t-107- 61Eyere-A\ YYNOA WQ j qZ5,;'�G •1-771 <br />TENANT NAME CONTACT FOR PERMIT PHONE q25-14$1.7&,(Oy <br />��aI 1 ie— I ���I% Je 1('GL �l��n�c�n EMAIL ie; ro 1 V . <br />Ecat <br />CONTRACTOR ADDRESS CITYIZIP H E <br />Cmu3yk Fire-�b goX 013 NZ6-y81-76t9 <br />CONTR.LICENSE# Mitt Creek, WA ciSLtsZ <br />CA o wti Fi��l t_� <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I <br />Electric Gas Other <br />`t10.0.00 <br />L <br />_ _ _ <br />WORK DESCRIPTION <br />KA& cvb dire �pr��k�er Y�' <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />AIC— airhandlingunits <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />_ <br />Range hood <br />_ <br />Sink(service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow, preventer <br />Heat pump <br />Urinal <br />Unit healer <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify 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 violate 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 owner of this property to perform the work for which application is made and I comply with the <br />State nlractors Law 18.27 RCW and 296.200 WAC. <br />Signa re o wner/Cont ac or/Authorized Agent Date <br />01 <br />