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l � <br />PtRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, 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 />.., j L� 1' � 11 .S /' ., <br />LEGAL �.OT NO. BLOCK <br />DESC. <br />OWNER <br />��'C, i«. _ <br />TENANTNAME <br />�� � � �v�i� i � � <br />CONTRACTOR <br />CONTR. LICENSE M <br />USE OF BUILDING <br />�;�N��� l r-1;,, �'�� ��a��ce <br />WORK DESCRIPTION <br />f=l Tl����J - J'�111 <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />�_ Lavatory (wash basin) <br />� f_ Shower <br />� Kilchen sink 6 disposal <br />�_ Dishwasher <br />Clothes washer <br />Water heater <br />Sink (ser�ice/bar/mop/etc.) <br />Backllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Other <br />PARCEL TAX I.D. N <br />TRACT <br />ADDRESS <br />� ��'G' �� 17 i,l Yl�.'i �. <br />CONTACT FOR PERMIT <br />�;�� I )/VF 1 1' <br />ADDRESS <br />HEAT SOURCE <br />_ Electric � Gas _ Other <br />PERMIT A <br />t`c,�t�/tl k,'q ��( ZG / �iG <br />/�5�d'j PHONE <br />CITY2IP PHONE <br />I CONTRACT PRICE OF WORK <br />NO. � TYPE OF FUCiURE OR ITEM <br />A!C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y thal I have read and examined this application and know lhe same lo be true and cortect. All provisions of laws and <br />ordinaces gorerninc� this type ol work will be complied wilh whelher specified herein or not. The granting ot a permit does not presume <br />to givo aulhorily to violate or cancel the provision of any other slate or local law regulatlng construction or lhe performance of <br />construclion. Thal I am authorized by lhe owner of this property to perform the work tor which application is made and I comply with the <br />State Conlractors Law 18.27 RCW and 296.200 WAC. , / <br />