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PERMIT APPLICATIC)d <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />` ;1-7 —el-5 <br />425-257-8810 — FAX 425-257-8857 — w., w.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS / PARCEL TAX I.D. # PE5MIT� # — <br />!!// <br />/.' <br />LEGAL LOTNO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY2IP PHONE <br />J'Aacaikc-k pie 1L-t�tl-off <br />TENANT NAME <br />I CONTACT FOR PERMIT PHONE <br />CONTRACTOR }7:5 (k V4 DQ CLOPV,,&j ADDRESS IiV(k - ', ., LI. CITY/ZIP HONE <br />CONTR. LICENSE # 60 ,Z 199 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric _ Gas _ Other <br />I <br />WORK DESCRIPTION <br />D16 CA S ✓v <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 />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heal pump <br />Unit heater <br />_Urinal <br />_ <br />Drinking Fountain <br />Boiler <br />drain <br />Refrigeration <br />_Floor <br />_ <br />Grease trap <br />Woodstove <br />_ <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 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 />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature o �caner/Con raclor/Authorized Agent Date <br />L <br />am <br />