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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 — m w.everettwat.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />ME LE: 75(5 se 71 51-5r r -4,- , ggc4o <br />ANTNAME <br />7k- <br />OR PERMIT PHONE <br />I Z <br />Ljaa�a lr- <br />`BLS <br />CO�t TRACTOR ADDR S ITY/ZIP PHONE <br />1�DVA",c-b F'-ac-- 41c T c 7cii M7?�=> 04 '7-' kC ti qzs -*5 s6s7 <br />q)LML <br />CONTR L�CEN !# I�T� <br />1�>E7FP (Gr9-,P,6 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACTPRICE OF WORK <br />4L <br />_ Electric _ Gas _ Other <br />WORK DESCRIPTION J <br />_I t>Si7rL( rtFc <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas pipinn <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />(service/bar/mop/etc.) <br />Exhaust fan <br />_Sink <br />_ <br />Backflow prevenler <br />Heat pump <br />Urinal <br />Unit heater <br />Fountain <br />Boiler <br />_Drinking <br />_ <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <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 />Slate lclors Law 18.27 RCW and 296.200 WAC. <br />f <br />�= <br />4 <br />Signatire of .rner/Contractor/Authorized Agent Date <br />