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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 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />%SU <br />ZSuY/Lcc,4 Csoc, <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC <br />OWNER ADDRESS CITY/ZIP PHONE <br />Z I M/7 c•" M 1IV, S 9 /( S a1.%L �,s{�} ;- 5rX-'/'4.tic G.A <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />TCclI � �ti' <br />SicvL /SLc ,�h L12.S- 726 E'3S- <br />CONTRACTOR ��_� ,. ;� ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />/S'e.iryNtc, ; 7c.,. r}2.>-77L SrS 3s' <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />_ Electric —Gas —Other <br />c. n <br />zi CWORK <br />DESCRIPTION ii Ve Le(-, <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C - air handling units <br />_ <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink 8 disposal <br />Gas (replace <br />_ <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 />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />Floordrain <br />Refrigeration <br />_ <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 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 a, authoriz he ner of this property to perform the work for which application is made and I comply with the <br />State Contractors 18. .200 WAC. <br />Signal of ner/Contractor/Authorized Agent Date (/ , <br />l v <br />