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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 3 `) —0'6 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />5e-.,G7- sE Nkll w�, <br />s .� 3oN3Uo <br />M��o3 as <br />LEGAI LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER / ADDRESS CITYIZIP PHONE <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />CONTR CTOR ADURESS � CITYIZIIP PHONE <br />Nlan v63o /6 3_ ` Tz"' N�1 <br />CONTR. LICENSE # G" e' ^f <br />M��—rNL=163c-N, `3gU73 <br />USE OF BUILDING <br />\ <br />HEAT SOURCE <br />I CONTRACT PRICE OF WORK <br />ce <br />_Electric Gas � Other <br />�I o25 G <br />WORK DESCRIPTION Q -.S t (�S Ylw-K <br />p���tl l/ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — airhandlingunits <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water healer <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Range hood 1 <br />Exhaust fan R� OcA-4Z. <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 />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify 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 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 />67-3-ls - G (,' <br />Signature of Owner/Contractor/Authonz Agent Date <br />