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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 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />/gib /�,y�c✓ & ,L <br />CvS'� <br />LEGAL LOT NO. <br />!BLOCK <br />T ACT OR SUBDIVISION # <br />OWNER PNVE-L ADDRESS CITY2IP ONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />EMAIL <br />CONTRACTOR ADD E S —STY/ZIP P -• <br /># n (V I✓- <br />CONTR. LICENSE <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />—Electric _X Gas —Other <br />WORK DESCRIPTION <br />66v <br />reL.Dfe Fl• 7-2.e3o = <br />CV. o,, iv C+CCV ,rLjLf00X+1 = 44o S,F. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C - air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />_ <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Walor healer <br />_ <br />Range hood <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />BackBuw prevenler <br />_ <br />Heat pump <br />_ <br />Urinal <br />_ <br />Unit heater <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodslove <br />_ <br />Roof drains <br />Other <br />_ <br />Other <br />CIl , OF EVERETT LOCAL SALES <br />TAX <br />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 />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 state 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 />Stale Contractors Law 18.27 RCW and 296.200 WAC. <br />(21 70 o <br />Signature o - ner/Conlraclor/Authorized Date <br />t/L <br />