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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STF.cET, EVERETT, WA 98101 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO PM <br />S,ID�EE ADDRESS <br />PARCEL TAX I.D. Ite <br />PERM�Ti <br />ry <br />16 <br />7595 <br />I(a eSo� <br />D¢ 6' <br />LEGA LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION 0 <br />DESC. <br />OWNER ADDRESS CITY2IP PHONE <br />6 1 CI,LffC7505 'fLlw4—>F YI Rel &42Tt�� - <br />TENANT NAME CONTACT FOR IERMIT PHONE <br />? 5 - 3e:q 3 - 6 3 / 5' E-0an1L <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE N <br />ow Yo,� <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I <br />— Electric Gas Other <br />p'J <br />3, g ✓ U. <br />WORK DESCRIPTION /0'75/c (/O1/7 111 ?Si i A s <br />G VVAII Slsljs <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 />Bathtub <br />i <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 />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />_ <br />Sink(service/bar/moprelc.) <br />Exhaust fan <br />Backflow prevenler <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boller <br />Floor drain <br />Refrigeration <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 cerilify that I have read and eyamined 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 fcr which application is made and I comply with the <br />State Contractors Law 18.27 R�CW and ^96.200 WAC. <br />Signalur�� or/AutI zed Agent Date r( <br />