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PL MIT 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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS IC ' <br />;�]J� V � ' i <br />PARCEL TAX I.D. # J� <br />C, C <br />ptMIS�\ I <br />I7 V <br />LEGAL LOT NO// ���{{BLOCKI-� TRACT y!- <br />DESC. I5 1 1 ' D .t j �)U `�Vt•J6.l.l <br />OWNER ADDRESS CITY/ZIP PHONE z <br />�>v hc�c�e 132 z� 6z5� D2�i0 6Z� <br />TENANT NAME <br />I CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING (��� <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />'JUSC(� I e, � `W) I '� <br />_ Electric _ Gas _ Other <br />I <br />WORK DESCRIPTION <br />Re..plac.. t?SdsT-it-Ij ccy-��- <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C - air handling units <br />Bathtut <br />_ <br />Forced air systems <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gasrange <br />Ciothes washer <br />Clothes dryer <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/bar/mop/etr,.) <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 />Grease trap <br />Refrigeration <br />Woodstove <br />Roof drains <br />Other <br />_I <br />0!her <br />- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritity !hat 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 authodty to viol or cancel the provision of any otter state or local law regulating construction or the performance of <br />construction. That I a au horized by the owner of this property to perform the work for which application is made and I comply with the <br />0 State Contractors La 1 W and 296.200 WAC. <br />Signature of Owner/C actor/Aut razed Agent Date <br />