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P6MIT APPLICATI6N <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 /0—/6 --0,7 <br />SITE ADDRESS 7S05 Hodejod 9 <br />PARCEL TAX I.D. # <br />RMITA <br />6/ 3 <br />Ev et WA <br />1,2 O -OC)6-- o6?no <br />LEGA LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION 0 <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />f3cthe( J/�4viC C/a.sZcGl <br />,t <br />V/0 lhik 75505 ffociES-oxIo <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />1ST - NO- 7/79 <br />E41AIL <br />CONTRACTOR ADDRESS <br />R%t� 7fl�lS?68' c.-o <br />( <br />CONTR. LICENSEK /rTJV/1!✓l. VV%Ol7� `plSlilf /M//: #ple F141 36D .�cr-�i�r <br />USE OF BUILDING <br />HEAT SQURCE <br />CONTRACT PRICE OF WORK <br />Electric _ Gas _ Other <br />got O00 — I�V 000 <br />WORK DESCRIPTION <br />��cee*aVgC <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />VC — air handling units <br />Forced air systems <br />Bathtub <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />_ <br />Water healer <br />Sink (service/bar/mop/etc.) <br />Range hood <br />Exhaust fan <br />_ <br />Backfiow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Floor drain <br />Boller <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify 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 stale 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 />Stale Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of er/Cont a r/A h nz Agent Date <br />