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� 425-257-8810 —FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM q <br />SITE ADDRESS <br />PARCEL TAX I.D. # I PERMIT # <br />�) `' �7' L LL <br />U 0'-I v G ` 3UD � U > > <br />LEGAL LOT N0. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />TENANT; <br />FOR PHONE ZL'Yp S�jSZ`(�p <br />7NA�ME- (� �`CONTACT <br />C�%'r/'Lr/l ( Y�li' { <br />jPERMIGTl� <br />E-MAIL Q SPLLIIIi6IYIG G <br />-PHONE <br />NT A TO AJDRES � ITYI P <br />n` <br />11oP�iNSIia2� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric Gas Other <br />2 5 OCl�:) tom(] <br />WORK DESCRIPTION <br />CAS i Lf�C <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />(n <br />Toilet <br />A/C -air handling units <br />Bathtub <br />Forced air systems <br />� <br />Lavatory (wash basin) <br />� <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink &disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />_Clothes <br />dryer <br />to <br />Water healer <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 />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I 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 />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 properly to perform the work for which application is made and I comply with the <br />State Cgnlraclors Law 18.27 RCW and 206.200 WAC. <br />r/ -(O •US <br />Si nature Owner/Cr/ ulhori ed Agent Date <br />7-c <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />