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PERMIT 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 - f! <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />yZS 4- C�%� <br />0g0a -COLA <br />LEGAL LOT NO. BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />Min? h' G/ SG@7�oN - `'-/Cg' �<'� _ <br />TENANT NAME CONTACT FOR PERMIT PHONE yam,. 0i0 - J79W <br />A,kj '0S aW E-MAIL <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />No,E' sr&H l-li4TinJG elos- 'er' �/[4f9 <br />CONTR. LICENSE # �+-/ <br />NoeQSlNR 97S""/C/�' 617/ 7 �j7 qU� NF N/a2YSU/CL c A �W 70 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric <br />9 ` <br />/�GnF <br />—Gas —Other <br />WORK DESCRIPTION <br />GAS 6,06 i7� w%�T�.C' /if. T/✓e STbvE <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 />_ <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />2_ <br />Gas piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />_ <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 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 stale or local law regulating construction or the performance of <br />constr bq. That I am authorized by the owner of this property to perform the work for which application is made and 1 comply with the <br />e Con actors Law 18.27 RCW and 296.200 WAC. <br />/err -d <br />`Date <br />ignature of Owne ractor/Authorized Agent <br />