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PEkMIT APPLICATION <br />PE�MIT APPLICATION <br />SERVICES <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />.ss_sr.es�o-r�u.... zn.eu�_...e,.�.u.... <br />425-257-8810 —FAX 425-257-8857 — www.everettwa.org <br />. tiE <br />a3 -06 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />O-jW�NER ADDRESS CITY/ZIP PHONE <br />/ <br />b <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Sik�`1i�1 � -[��z� � 5 c1" �7 � `D <br />CONTRACTOR ADDRESS CITYlZIP PHONE <br />IUl2i li.�(— CJf� lv to SC �+�LTr V�lr�l( w� Q zc-�c��-v4cv <br />CONTR. LICENSS # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I <br />Electric � Gas _Other <br />WORK DESCRIPTION <br />WORK DESCRIPTION <br />M <br />N�U U�= iz�:-mot- D�wto w A- 1 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />N0. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C —air handling units <br />_ <br />Bathtub <br />_Forced <br />air systems <br />_ <br />Lavatory (wash basin) <br />_Gas <br />piping <br />_ <br />Shower <br />Water healer <br />_ <br />Kitchen sink &disposal <br />_Gas <br />fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_Exhaust <br />fan <br />_ <br />Backflow preventer <br />_Heat <br />pump <br />_ <br />Urinal <br />_Unit <br />heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />_Refrigeration <br />_ <br />Grease trap <br />Woodstcve <br />_ <br />Roof drains <br />_Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 oresume <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 properly to perform the work for which application is made and I comply with the <br />Stale Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />l� <br />