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APPLICATION <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 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # -� <br />�j co <br />rSOn <br />LPG AL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />� � <br />7e. 7-red ay � 0 1' � �r'GP, �o 14 Je(� � zs �,o, <br />l� e�4-� <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />E-MAIL <br />CONTRACTORe � a rp ADDRESS p QV3 ?C) 1 � CLY��I..Q-�- PH <br />Ls- I °Z <br />CONTR. LICENSE#TKED V,/t✓ <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />q <br />�Y' <br />I <br />Electric _Gas _Other <br />� �{ <br />WORK DESCRIPTION <br />Ql-�,� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. � TYPE OF FIXTURE OR ITEM <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 />Water heater <br />Kitchen sink &disposal <br />Gas (ireplacF <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (service/Dar/mop/etc.) <br />Exhaust fan <br />_ <br />6ack(low preventer <br />Heat pump <br />_ <br />Urinal <br />Unit healer <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 />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritity 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 slate 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 />Stale Contractors Law 18.27 RCW and 296.200 WAC. <br />u IS b <br />S*ne of Own Can ractor/Authorize Agent ate <br />J <br />PERMIT <br />