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PL-RMIT 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 />APF; ICATIONS ARE ACCEPTED FROM 8 AM 'f0 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />wo "�__vue_w WA W <br />PARCEL TAX I.D. # <br />PERMIT # <br />�_ <br />LEGA LOTNO. <br />BLOCK <br />TRA T <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />'Recm-) <br />Y25 - fBJ- Z&0 <br />CONTRA TOR ADDRESS I IP PHONE <br />Cvown 1 Ivy PWeChxn 49w w )n rorba41J/-766q <br />CONTR. LICENSE # 6C)41,o111 A -A L?*012 <br />USE OF BUILDINGII <br />HEAT SOURCE <br />I <br />( CONTRACT PRICE OF WORK <br />LA 0 <br />mj'GaA <br />CJO a <br />Electric Gas Other <br />`I 'co <br />— _ <br />WORK DESCRIPTION <br />1P1� Ct) head <br />�o �� C7)�ads <br />>geco� CLO 1nz0'AS <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />_ <br />A/C —air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gasrange <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Laundry tray <br />_ <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerifify 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 Ca/ll ntraactors LLaaww/18.27 RCW and 296.200 WAC. <br />SI ature o. Owner/Contractor/Authorized Agent Date <br />