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� ARMIT APPLICATN�NCIiVOFEVERERPERMrtSERVICESev.�.ree�o-runzszna�n...e»nn.o�mo��f:�rl�Y�ln'M1C`.(k�,+„�34�¢'.....<,....r._.............�...,F...,.,:.:.....,......_.. APPLICATI� <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. # P RMIT # <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />OWNER <br />R�f� � �FlI Ly/).�NC(fj AD �'h'cE SL-'SPc�n»S�N�ld5j39�-9/ <br />V S � l iy <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />- <br />C i1, sfJti'fl L `/I� SK (. l K �.�5 % 9a',3 ��3/ <br />CONTRACTOR Gil /r� 11 y ADDRESS CITY2IP�,cI PHONE <br />7 <br />�� � �1� <br />CONTR. LICENSE # , ��/ � �/� • �� /-���" ?�� �/J <br />(�A <br />r <br />USE OF BUILDING <br />HEATSOURCE <br />CONTRACT PRICE OF WORK <br />—Electric � 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 />1 _ <br />A/C -air handling units <br />Bathtub ✓ <br />r <br />Forced air systems � <br />Lavatory (wash basin) <br />ice— <br />Gas piping <br />Shower <br />� <br />Water healer <br />_ <br />Kitchen sink 8 disposal <br />I <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />� <br />Clothes dryer <br />Water healer <br />Range hood <br />� � <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow prevenler <br />Urinal <br />Z <br />Heat pump <br />Unit heater <br />Drinking Fountain <br />•�'- <br />Boiler <br />Floor drain <br />cJ <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 />i hereby cerilify that I have read and examined this application and krow 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 �,Iranting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construelion or the perfcrmance 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 />Slato Contraclo s Law 78.27 RCW and 290.200 WAC. <br />gigna�tue.a'of ���.cc <br />Owner/Contractor/Authorized Agent <br />Sc 3sZ�7 t/2 <br />