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PLr�MIT APPLICATICi�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 58201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />10 <br />LEGA LOT N0. <br />DESC. <br />OWNER <br />�� ti A c. �> <br />TENANTNAME <br />CONTRACTOR <br />CONTR. UCENSE • <br />USE OF BUILDING <br />��5 k St, <br />BLOCK <br />Ci � (�p R T <br />QWHC rZ <br />�tjl CPi n �{ <br />PARCEL TA7( I.D. N <br />DoS�YYoo4oe6o� d <br />TRACT �� <br />�, o ,c�5 4 sf, <br />CONTACT FOR PERMIT <br />ADDRESS <br />HEATSOURCE <br />� Electric i�, Gas _ Other <br />IPERMIT/ <br />x0�lf�—Oto <br />CITYZP PHONE <br />�.Y-f1 ��ao� ytt �8- <br />PHONE <br />CITY2IP PHONE <br />I CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />���srncl (s-+nt i-�nc w�T�-+ 'iS+..b� Fe¢ K�S c�a5 F�wc/le«� R�t, waJeil�c�{e� tdaYert. <br />� Relac.�le S.y'lyd �awi.. L�nrt .�ir wusl�r ll.aa.dty si�JC f wa1..4a�ci <br />I a r 'b �c - Iw !. � w'TM <br />PLUMBING ECHANICAL <br />N0. I TYPE OF FIXTURE OR ITEM NO. I TYPE OF FD(TURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 dispos3l <br />Dishwasher <br />Clothes washer <br />Laundry Vay <br />Sink (service/badmopletc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />6chaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 grantlng of a pertnit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating consWction or the perfortnance of <br />construction. That I am authorized by the owner of this property to perform the work far which application is made and I comply with the <br />State ontractors Law 18.27 RCW and 296.200 WAC. <br />� _� _ Q.�C � _�— /o%� �nd <br />