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PLAMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.oi g <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT f IRDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. 0 <br />PE,QMIT $ <br />'4 ( - �TRuNcti AVM <br />�cf uSS'G�l OC 3-0 <br />l/�I <br />LOT NO. <br />BLOCK <br />TRACT '�ZGZ <br />ESC. <br />D SC <br />; C -S� �� <br />OWNER ADDRESS Q CITY 'PIP PHONE <br />_A a n a. F _�l (J(2J s o t'10-- � 35'AVg-SE Y,hr�(..i1$S ��uld �1.1s- 143-1'f 18 <br />TENANT NAME �- <br />CONTACT FOR PERMIT PHONE <br />I -7gt "�-I'I t <br />CONTRACTOR ADDRESS CITYrZIP PHONE <br />lA���;-L_r_'T�1�o..�lZ.:.�rg l'lu-3a-3st'F�u�SE 6vhu.►►_f��ot�, was-�V's�l'1l� <br />CONTR. LICENSE M <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric _ Gas ✓ Other <br />I <br />WORK DESCRIPTION <br />U <br />SSG ll <br />PLUMBING <br />_ <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — airhandlingunits <br />i <br />Bathtub <br />�_ <br />Forced a'.r systoms <br />I <br />Lavatory (wash basin) <br />LI <br />Gas pip,ng <br />Shower <br />I. <br />Water heater <br />I <br />Kitchen sink & disposal <br />1 <br />Gas fireplace <br />I <br />Dishwasher <br />i_ <br />Gas range <br />t <br />Clothes washer <br />—� <br />Clothes dryer <br />Laundry tray <br />Range hood�(Ylrpz <br />_ <br />Sink (service/bar/mop/etc.) <br />/ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pu•np <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />�f_ <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisio-•s of laws and <br />ordinaces governing this type of wort, 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 pe-form the work for which application is made and I comply with the <br />Slate Contractors Law 18.27 RCW and 296.200 WAC. <br />1(—(te <br />�,/ <br />Si nat e o wneu ontract r/Authorize A Date <br />II? <br />