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NOMMONNEWf <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 />t- <br />onso 3e.0 <br />v '5 Z <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />(2ct .tile i5'c� n;z2�� <br />1,Ilcr HULTF y�5=771 `ems>s' <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />3r7z6'>t L'c77� s5/6 CC 7�{c� �1wc21�Escx rrl� czc��rTT /�5 7?6 <br />CONTR. LICENSE # I D �r 3 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />(2t 0 LZ I <br />_ Electric _ Gas _ Other <br />Al 9 <br />WORKDESCRIPTION /U&T7i71L 3 c�9 f2'�et 4>tq� /1i1f17t.U%�� �(�C' -�(lcZ CC7TZ1< <br />TO t�4157T)UG- C IGzCL� 17 S <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 />Dishwasher <br />_ <br />Gas range <br />Clothes washer <br />_ <br />Clothes dryer <br />Laundry tray <br />_ <br />Range hood <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 ceritify 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 Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date t L 1 <br />