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PERMIT APPLICATION i,rldu1 <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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX LD, # <br />.99RMIT II <br />14 -Mo CQV .-'I"& i)U%�- <br />k6 <br />LEGA LOT NO. <br />BLOCK <br />TRA :T <br />DESC. a <br />3--�. <br />1' <br />0, (A"'J. i-a �&CkkV"Z" <br />OWNER ADDRESS CITYIZIP PHONE <br />A cy, <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS I CITYZII�P�� PHONE <br />1-IC)t��- �AU�P �.UTv.�r.xy45bl�- �{aS-1V3lll <br />CONTR.LICENSEN ��citw-tro,.��I <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I <br />I <br />— Electric _Gas �Other <br />WORK DESCRIPTION <br />bbb <br />ALL- �/4/ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C - air handling units <br />_ <br />Lathtub <br />t <br />Forced air systems <br />44 <br />Lavatory (wash basin) <br />�_ <br />Gas piping <br />_l_ <br />Shower <br />�_ <br />Water heater <br />i <br />Kitchen sink & disposal <br />1 <br />Gas fireplace <br />t <br />Dishwasher <br />I <br />Gas range <br />Clothes washer <br />I <br />Clothes dryer <br />_ <br />Laundry tray <br />I <br />Range hood- plitu <br />_ <br />Sink(service/bar/mop/etc.) <br />4 <br />Exhaust fan 1 <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />U inal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />_I <br />Refrigeration <br />Grease trap <br />Wcodstove <br />t <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I haves read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this 'ype 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 />State Contractors Law 18.27 RCW and 296.200 WAC. <br />J <br />`mac L. <br />Signatur of Owner/Contract /Authorized A ent ate <br />A!L .5l .29.J <br />