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PiLAMIT APPLICATIGA <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 _ Q <br />SITE ADDRESS <br />PARCEL TAX I.D. 11 <br />PERMIT N <br />ei L') xk 4 1� "6'I \l <br />e'plo — 001 <br />LEGAL LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION p <br />OESG <br />OWNER ADDRESS CITYIZIP PHONE <br />Qur�c=; 0.2 1�4'" /'r�� NE% �JO\ <br />rJr.;u�ir_r� <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE f� ` L <br />E-MAIL <br />R D I PH <br />CONTR. LICENSE # — <br />�- <br />C�- <br />USP�OF B}11LDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />N <br />l <br />(-�'JC]( <br />f"GGIe (,wA <br />_Electric _Gas _Other <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />I <br />Toilet <br />A/C — air handling units <br />Bathtub <br />Forced air systems <br />= <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />_}_ <br />Water heater <br />_ <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />/ <br />Backflow prevenler <br />Heal pump <br />Unit heater <br />_Urinal <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Wcodslove <br />Roof drains <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinances 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 Coplrectors Law 18.27 RCW and 296.200 WAG. <br />Signature of Owner/Contractor/Authorized Agent Date <br />