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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 — wvrw.everettvva.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. rl <br />PER <br />LEGAL LOT NO. BLOCK <br />TRACT <br />DESC <br />ADDRESS CITY/LP PHONE <br />rOWNER <br />1 / <br />}'; 1'2 l I T •l1� 11 �. ,n .. _7 Y` d 7 � 7? �i '-Y. i.,Y � ✓. �`✓rv`c � 1 ��. � <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />i <br />CONTRACTOR l ADDRESS CIT'YMP PHONE <br />CONT . LICENSE M L`�+� •7� <br />94 9 3q <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />L„ re, r <br />I <br />X Electric <br />'l ,n <br />—Gas —Other <br />WORK \DESCRIPTION <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 />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />— <br />Water hraler <br />_ <br />Kitchen sink & disposal <br />Gar fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />j <br />Sink (service/bar/mop/etc.) <br />I <br />Exhaust fan <br />_ <br />Backfiow prevenler <br />I <br />Heat pump <br />Unit heater <br />_ <br />Urinal <br />Drinking Fountain <br />__ <br />Boiler <br />Refrineration <br />_—_ <br />Floor drain <br />Grease trap <br />Wocdstove <br />_ <br />Roof drains <br />Other <br />_ <br />Other_ _ <br />-- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 77C5 <br />I hereby centify that I have read and examined this application and know the same to be true and corteef. All 01`6090119 of lain AMd <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 slate 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 />State Contractors Law 1 RCW and 296.200 WAC. <br />.227 <br />�tw+ w L�'>t. 4:2 - '�? "d;1_� <br />Signature M OwneriGontraCtOrIAUthorizec! Agent ate <br />