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PERMIT APPLICATION <br />CITY OF EVERETT PER' 1T SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wt,vw.everettwa.org <br />APPLICATIONS ARE ACCEPTED f-r?OM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # <br />N <br />P/p7/�R-MIT #L,!/` /_ <br />^ , I t <br />3 lW <br />U 1O/ &/O <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC, <br />OWNER ADDRESS CITY/ZIP PHONE <br />7(tie/'e54i 7PO -"Is3 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />2rC4ct 6t( �oLr, 2- <br />CONTRACTOR C- eF-E-i -✓mac( Cuic,6rc,c E,1DDRESS 1,55.1- /e2- CITY/ZIP PHONE <br />rf <br />/ �/", <br />S hG PM )3,e G �f "C � 1/1W <br />CONTR. LICENSE #L; E%/G J 032 L <br />iJei o/8005 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />t ePal-�y>7C/16 I <br />— Electric Gas Other <br />I / <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 />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <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 />_ <br />Exhaust fan <br />Backflow preventer <br />_ <br />Heal pump <br />_ <br />Urinal <br />Unit healer <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Wocdslove <br />_ <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 - xrect. 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 />construction. 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 />Stale Contractors Law 18.27 RCW and 296.200 WAC. <br />✓ <br />Signature of Ownerl ontraclor/Authorized Agent Date <br />