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it <br />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 />�,s sc 17Vz' -4_ iv> 11 t�-y <br />,�a- <br />LEGAL LOT NO. <br />BLOCK <br />, <br />TRACT <br />DESC. 'y' <br />CA <br />OWNER ADDRESS CITYIZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Y,,-A <br />JVL,SeQ_ P/Zs G0�7 y37:2 <br />CONT�{ACTOR ADDRESS CITYIZIP PHONE <br />h1 n 1 A at U -' I <br />. -rv.c. Zae ,j <br />CONTR. LICENSE • rlU-)3 <br />t- l"i S- I (o 3C <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />ev�s <br />I <br />— Elecldc —Gas —Other <br />i <br />WORK DESCRIPTION 1 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — airhandlingunits <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping n <br />Shower <br />Water heater <br />Kitchen sink 8 disposal <br />Gas (replace <br />Dishwasher <br />Gas range (J(/ <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backtlowpreventer <br />_ <br />Heatpurcp <br />Urinal <br />Unit heater r <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Z <br />Grease trap <br />Wcodslove <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 presume <br />to give authority to violate or cancel the provision of any other stale 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 />-e- z <br />Signature of Owner/Contractor/Auth zed Agent Date ) <br />