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PERMIT APPLICATION <br />CITY OF EVE:RETT 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 />Na.0 <br />PARCEL TAX I.D. # <br />PERMIT # <br />305- S 0 L&rev- wo <br />2go-57wo 3C)q30o <br />i'oCno3-cn3 <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />OESC. Q�-- <br />OWNER ADDRESS CITYIZIP PHOONE-�yy,r <br />1 <br />5Y -0/00 31itr1tJC <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Nr.k <br />e.Q-y1�5 -fco2 �137� <br />CONT'RjqCTOR ADDRESS CITYIZIP PHONE <br />/vM I AAeot— 11573 a W e Allis <br />CONTR. LICENSE# Z S <br />Mt�2s, �fL 1103ch'\ <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />� �, <br />-- Electric JC-Gas Other <br />I <br />WORK DESCRIPTION <br />V <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE na ITEM <br />Toilet <br />A/C — air handling units <br />Bathtub <br />Forced air systems <br />Z <br />Lavatory (wash basin) <br />__ <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />.� <br />Grease trap <br />Woodstove <br />_ <br />Roof drainqs <br />Other Ibl— 46-A + <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 />3 - 06 <br />Signature of Owner/Contractor/Authon ed Agent Date <br />