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P'LRMIT APPLICATON <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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />I <br />PERMIT # <br />�0 2 <br />%/1% 02 ' .riXPY <br />e'v 393 3aoa // 7a e) <br />all <br />LEGAL LOT NO. BLOCK <br />TRACT'02, <br />le <br />OWNER ADDRE UIY2IP PHONE <br />'/ �13// <br />FT/ e-2%iX) /O016AL C 4-k1� z/2S 337-7/� <br />_P/- <br />TENANT NAME <br />CONTACT FOR PERMIT ONE <br />CONTRACTORAThl ADDRESS yzjG /k/L5/ sc CITY2IP�/ PHONE <br />p <br />(///LZIrri✓ /%.�/(/r%-�5� �V CI�`�nrF/ �/� S'�%�i/—//�Q <br />CONTR. LICENSE # <br />9ko/ z <br />USE OF BUILDING <br />HEAT SOURCE <br />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 />_ <br />Bathtub <br />_ <br />Forced air systems <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (servicelbar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <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 />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 state 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 nd 296.200 WAC. <br />/ <br />Ly/� / �z <br />Signature of 0WnerContragftorlAuthonzed Agent 'Date <br />