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PLRMIT APPLICATIG,J <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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX LD it <br />PERMIT # <br />o.,_ <br />)IT t <br />' <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />S� im.TS vot SO l ce._ 171?,PfV)1 <br />76o FAO z �9 7 S <br />CONTRACTOR I) V 4 K 1_ L_ (,. 4' IMG C i{ ADDRESS /go BOA- 7 (0 9 CITYIZIP PHONE <br />CONTR. LICENSE # <br />II) Ph -k f- C 6 0 4 P-xi 6 7_ 2 3 In ko a .?7 s�r <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />V I C e (3 tL <br />I — Electric Gas Other <br />I J�/ �j U c, <br />WORK DESCRIPTION 5 !f1-CC V !/✓ <br />1, � �C�' G-kUu v(j <br />PLUMBING <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C —air handling units <br />Bathtub <br />_ <br />Forced air systems <br />-� <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />Water healer <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />Dishwasher <br />_ <br />Gas range <br />Clothes washer <br />_Clothes <br />dryer <br />_ <br />Laundry tray <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <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 ceritify 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 picsume <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 />Signature of Owner/Contractor/Authorized Agent / Date <br />