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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 <br />SITE ADDRESS <br />PARCEL TAX I.D. # PERMIT #_ <br />LE6ALI LOT NO. <br />BLOCK <br />TRACT <br />DESC r_SS <br />• ard_.n #-R505300212 <br />OWNER � ADDRESS CITY(OP PHONE <br />P'dr4 012MO <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />4,?kao4k <br />I <br />CONTRAC OR ADDRESS CITy0P PHONE <br />CONTR. LICENSE# AlIjeol tt (n 1 <br />USE OF BUILDING <br />HEAT SOURCE <br />PRICEOF WQRK <br />I <br />ctnc <br />}CONTRACT <br />I.%� I <br />IIJLTL[ Arh1 Y I��irbt^'-hlL� <br />—Gas —Other <br />WORK DESCRIPTION <br />i <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />a; <br />Toilet I ' <br />A/C - air handling units <br />2 <br />Bathtub r! <br />L <br />Forced air systems <br />Lavatory (wash basin) IO I <br />Gas piping <br />Shower <br />Z <br />Water heater <br />Kitchen sink & disposal <br />— <br />Gas fireplace <br />Dishwasher <br />Gas range <br />%- <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backfiow pleventer <br />Heat pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstov <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 />ordinaces 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 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 />aw 18.27 RCW and 296.200 WAC. <br />State CM_� <br />1 11 h <br />Signs r eaContractor/Authorize Agent Date t� <br />