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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 S AM TO 4 PM 11_1t) -Id <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />r'1t011 -n�� <br />%'F1c Chi fir' 'v ;!� /✓a <br />LEGA LOT NO. BLOCK TRACT OR SUBDIVISION # <br />DESC. <br />CITY/ZIP PHONE <br />OWNER <br />CDRRESS <br />}�A,.,,D�e <br />TENANT NAME ONNTQ3TACT FOR PERMIT PHONE 2971 •71C7Z <br />��t <br />fN EN MAIL i c[ ! /Cr Y/7K <br />A /Z <br />KEY <br />CONTR. LICEN.iE # <br />Y11 Nzz <br />'C: HEAT SOURCE CONTRACT PRICE OF WORK <br />USE OF BUILC <br />I — Electric _ Gas _ Other <br />WORKDESCRIPTION Iy ST/�CC !Yc' <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toildi <br />_ <br />A/C — air handling units <br />_ <br />Galhtub <br />— <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />__ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink u disposal <br />Gas fireplace <br />_ <br />_ <br />Dishwasher <br />Gas range <br />Clothes dryer <br />_ <br />Clothes washer <br />Range hood <br />_ <br />Water healer <br />Sink (service/bar/rnop/etc.) <br />— <br />Exhaust fan <br />_ <br />_ <br />Backfiow preventer <br />— <br />Heat pump <br />Unit heater <br />_ <br />Urinal <br />Drinking Fountain <br />— <br />— <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />Other <br />_ <br />Roof drains <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined this application and know, the same to be true and correct. All provisions of laws and <br />ordinances this tvpe of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />governing <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />to the work forwhich application is made and I comply with the <br />construction. That I am authorized by the owner of this property perform <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />zo <br />Sttnature of Owner/Contractor/Authonzed Agent Date <br />