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PERMIT APPLICATION <br />CITY OF E�VERETAR STREET, <br />SERVICES y S <br />O�v <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS I PARCEL TAX I.D. 0 PERMIT # <br />11a24 J �t 'ri%za I I -P0`t��� �t���� ���V I �1 50.a 0o <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRFSS CITY2IP PHONE <br />( cl -T�(\ oY— p . , l 1at.�. �C .. w� l�(z ZSz - I u SSp <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />CONTRACTOR �AS `rn�'L✓'� ADDRESS <br />�iL-frciZS G <br />CONTR. LICENSE 9 , � �, ,.� 0 <br />USE OF BUILDING <br />HEAT SOURCE <br />tiyl T <br />Electric _ Gas _ Other <br />WORK DESCRIPTION <br />(Ae C/) 'Ju5 ( �`rQ•L <br />PHONE 5-4 f0 <br />CONTRACT PRICE OF WORK <br />& ao <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM -- <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry bay <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />BaGcFlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />— <br />— <br />— <br />_ <br />_ <br />_ <br />— <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby centify 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 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 />S ate Contractors Law 18.27 RCW and 296.200 WAC. <br />c <br />