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PERMIT APPLICATIUN <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 ADDRESERMIT <br />S r <br />I <br />PARCEL TAX I.D. # <br /># <br />� �JC`C� <br />17 O70 a—CId <br />LEGALI LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHOAE <br />L i ) <br />TENANTTNNA�ME <br />CONTACT FOR PERMIT PHOOE <br />CONTRACTOR ���vt-i b�NQPi LiS�ADDRESS f��3 /7(L,�tvtt�S.-CITMSPt�n PHONE <br />CONTR. LICENSE # �O� J y4 O C) <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I <br />— Electric Gas _ Other <br />WORK DESCRIPTION // I Y )/ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — airhandlingunits <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />_ <br />Water heater <br />_ <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothe,,; washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />_ <br />Range hood <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />Backflow prevenler <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Floordrain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodstove <br />_ <br />Roof drains <br />_ <br />Other <br />_ <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 />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 provisio f any other stale or local law regulating construction or the performance of <br />construction. That I am authorized by t own of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18 7 RCW 29 0 WAC. <br />Signat of Own Contractor/Autho Agent Dale <br />