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PERMIT APPLICATIUN <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 B AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.J. # <br />PERMIT # <br />I I . C. r �c e Err 1,4 `L- GLI Iq Y <br />_ <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />I«CSJgy0(-'N <br />1P1gC-I'- I-le.svE'e 61.25gP,3-r <br />4NTRACTOR ADDRESS CITY/ZIP PHONE ((q:2 n' <br />IS o h�0_ LAP-F_ PLUM 3 rk� /3s'oy c1E 17Y S i KiP_kL.9,uo, wA.9SU3y 820=7802- <br />CONTR. LICENSE # <br />CGts7,vCPorrsr �'�07 <br />USE OF BUILDING HEAT SOU CE CONTRACT PRICE OF WORK <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 />_ <br />Toilet <br />_ <br />A/C — air handling units <br />Bathtub <br />_ <br />Forced air systems <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 />Clothes washer <br />Clothes dryer <br />X <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 />Woodslove <br />_ <br />Roof drains <br />Other <br />Other <br />_ <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 euthorily to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />corgsGu tion. That I am authorized the owner of this property to perform the work for which application is made and I comply with the <br />State6ntracterr Law 1 27 RC and 296.200 WA.C. <br />1. <br />ignature of Owner/Contra for/Authorized Agent Date <br />