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r <br />PERMIT APPLICATHON <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 3 _ �� _ o % <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />P riMIT # <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 />q?-, - 210 --�32Z <br />,mow <br />CONTRACTO ^ t j S� AD 5 I IP P NE <br />iG( l>i+vl�1� �I2 zto <br />CONTR. LICENSE # — / / % /��7�4'j <br />USE OF BU LDING <br />HEAT SOURCE <br />CONTTRR/CT PRICE OF WORK <br />Electric — Gas _ Other <br />woRik DESCRIPTION �%� DX67``� v1'�3 st2-'o ror, <br />/ J / <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C — air handling units <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Shower <br />Z <br />Gas piping <br />Water heater D <br />�jt <br />Kitchen sink & disposai <br />Gas fireplace QC <br />Dishwasher <br />Gas range <br />Clothes washer,� <br />Water heater E-i 43 <br />Clothes dryer <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backilow preventer <br />Fleat pump <br />_ <br />Urinal <br />Unit heater <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 />Other <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 />ordinates goveming this type of work will be complied with whether specified herein or not. The granting of a pe,mit 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-Cbntractars Law 18.27 W and 96.200 WAC. <br />i <br />Signature of Ownerluo ac r/Au orized Agent Date <br />trz <br />