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F•`RMIT APPLICATIVN <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 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. If <br />PERMIT 8 <br />!e f o(0 ) arliJ <br />C�0(/ <br />LEGALI LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYILIP PHONE <br />ARke� U����h �1�,na� I��D-fiPL�e� fld 61L� CArriCO& Z0bg40l <br />TENANT NAME CONTACT FOR PERMIT PHONE (o <br />,��ZU <br />DAB �' i yl n EMAIL (/�Ir1 Li Ih n (CIDI-iol'Yy'k1� 1 . <br />CONTRACT § I' <br />CONTR. LICENSE # O(L) I) <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />5\ " "11-C F/1Vvn " \ y 1"V 'J' (W" (e <br />_ Electric _ Gas _ Other <br />I <br />WORK DESCRIPTION <br />n �5 <br />61'e4,y)C t�iri[n y\S GC f1U'Sc QF� �rrP <br />T <br />PLUMBING <br />MECHANICAL(/f <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash Imsin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />Kitchen sink d disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Water heater <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify that 1 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 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 I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />- : vcA (kl �( -1 b - (T� <br />Signature of Owner/Conlraclor/Authorized Agent Date <br />35- <br />M <br />