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PERMIT APPLICATIUN <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 />AP '�ICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # <br />PERMIT # <br />� � T <br />lVlcc>ao/-Oi/ <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />_ GITy D� Ca?eZ <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />/V /�(/ Z1&Z4 L1 I �ilH�ls L 425 25� Q�17 <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />72!5�W A/R.. <br />4;Z - 854 - 2770 <br />CONTR. LICENSE # 2&-7 :5�, /G07W 9MLE—T <br />USE OF BUILDING CONTRACT PRICE OF WORK <br />-HEATSOURCE <br />Electric _ Gas _ Other O 2-4 749, 82 <br />L.- <br />WORK DESCRIPTION <br />c4Y-I C- U1tllT IN 7/y,' 1-1264VI C'WP972512-. 0z" <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 />_ <br />Forced air systems <br />— <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />Water healer <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />Dishwasher <br />_ <br />Gas range <br />— <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />_ <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />BackOow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boller <br />Floor drain <br />Refrig::ration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />— <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 state or local law regulating construction or the performance of <br />construction. That 1 am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of O nerlContractorlAuthorized Agent D to <br />Z <br />