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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CLDAR STREET, c .'ERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org S� ay --o> <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS , (�y <br />PARCEL TAX I.D. # /' ) <br />PERMIT # <br />�J l <br />- BUD - <br />S . L'C. <br />LEGAL LOT N(�. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER r ADDRESS 7JC, ?3CITY/ZIP PHONE//9CNJ,(� � <br />TNT <br />/ <br />�r Sr9i�iy1�S L/�C /�la/ Cvefg(een y C�yC/Gfy /r3& `t <br />TENANT NAME CONTACT FOR P MIT PHONE <br />I'' fiCl ri y� f�4 4 )al- iC��'"7 e- <br />CnNTRACTOR / n� _ / ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE # <br />/C / (/ ✓ <br />USE OF BU'LDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />— Electric — Gas — Other <br />WORK DESCRIPTION <br />p <br />PLUMBING <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Yoilel <br />A/C — air handling units <br />83thlub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />washer <br />Clothes dryer <br />_Clothes <br />_ <br />Laundry tray <br />_i <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />_ <br />Roof drain.; <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cernify 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 aulho':ty 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 />Stata Contractors P", 18.27 RCW and 296.200 WAC. <br />Signature o Owner/C tractor/Authorized Agent Date <br />