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PERMIT APPLICATION <br />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 6 AM TO 4 PM /b— 12 —gyp <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT tF <br />/0 30 <br />�o L �PLC 1�Z <br />.ail <br />LEGA LOT NO. BLOCK TRACT OR SUBDIVISIGV # <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />SHr1/yr R FIA�yet/ �CI LAvP-� (�� £Yetzetl 4zS �/7& <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />E-MAIL <br />_ <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />aL {',cK 257t7 �i21z-K(nifl} 1,, <br />r wv <br />l�T� <br />CONTR. LICENSE If <br />P3r C H cz lot MA <br />USE OF BUILDING <br />HE^.I SOURCE <br />CONTRACT PRICE OF WORK <br />I — Electric Gas —Other <br />r <br />WORK DESCRIPTION <br />I <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />N0. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C —air handling units <br />_ <br />Bathtub <br />_Forced <br />air systems <br />_ <br />Lavatory (wash basin) <br />� <br />Gas piping I <br />_ <br />Shower <br />—Water <br />healer <br />_ <br />Kitchen sink &disposal <br />_Gas <br />fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />_Clothes <br />dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow prevenler <br />—Heat <br />pump <br />_ <br />Urinal <br />—Unit <br />heater <br />Drinking FountainBoiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />_ <br />Root drains <br />_Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby certify that I have read and examined this application and know the same to be True and correct. All provisions of laws and <br />ordinances 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 camel the provision of any other stat< ar loca! law regulating construction or the performance of <br />construction. That I am aulhori ed by the owner of this property to perform the work for which application is made and I comply with the <br />WAC. <br />Stale C ctors Law 1 .2 W and 296. <br />n� /6 /a-s0 _ <br />Signature Owner/Cont ctorlAulhorized Agent Date <br />