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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 PARCEL TAX I.D. # RERMIT# <br />1g02 S.E. Eterett Mall Wel <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />GNO- 3m sixwft Ave Piltsburjh PA 15�� <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />(Onmem(J &nwgiFs Inc. `ii Sly y lolls yU J3 8-67751W-3j6--W76 <br />CONTRACTOR ''jam ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE # 1 - � C"(Y� 1-y-f" r--4- L , <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />mQ.r(rl" i.0 - Vl fe1.m,f.1 rtblik" Electric _Gas /' <br />_Other T s ij) 907. 00 <br />WORK DESCRIPTION <br />j-I/!1/o�Trrwruarl- &.r710. /LLpuI AX %1/r[,f NYAC r/nii <br />/fq/"1i I f <br />J PLUMBINj MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <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 />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritiy 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 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 296,200 WAC. <br />Eel <br />