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-ERMIT APPLICATI6N <br />CITY OF EVERETT PERMIT SERVICES j D /o-O% <br />3200 CEDAR STREET, EVERETT, WA 98201 — - <br />ettwa.o \� <br />425-257-8810 - FAX 425-257-8857 - www.ever <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM P/o — 00'r <br />SITE ADDRESS PARCEL TAX I.D. S <br />77 05 Har" Or1 <br />LEGA LOT NO. BLOCK TRACT OR SUBDIVISIONDESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />Slc,l Il L��A 7 S�'S �.ct�elrr�c►� R� <br />l'ccL�s�ct� <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />C u ^ n . EMAIL <br />PHONE <br />CONTR. LICENSE N <br />USE OF BUILDING <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />— Electric Gas Other <br />WORK DESCRIPTION <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 />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />_ <br />Water heater <br />_ <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />Dishwasher <br />_ <br />Gas range <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water healer <br />_ <br />Rangn hood <br />_ <br />Sink (service/bar/mopletc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />Urinal <br />_ <br />Unit heater <br />Drinking Fountain <br />_ <br />Boller <br />Flocrdrain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodstove <br />_ <br />Roof drains <br />_ <br />Other <br />_ <br />Other iCC ,ncltiiK <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 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 />State Contractors Law 18.27 RCW and 7,96.200 WAC. <br />v.cl� <br />Signature of Owner tractor/Auth zed Agent Date <br />