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PURMIT APPLICATION <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 />ERMIT # <br />/<' <br />LEGA LOT NO. <br />BLOCK <br />TR CT <br />OESC. /5-- <br />/ <br />ADDRESS CITYIZIP PHONE <br />OWNERR�r <br />/ <br />CUcR-Ti�iC- i/✓�/ /OC��`nLSE� Fa �YQcP "/:j 237-77S7 <br />_�fI/rL� <br />TFNANT NAME <br />CONTACT FOR PERMIT PHONE <br />20Fffo '/,'j �32-71s17 <br />Cr)NTRACTOR ADDRESS CITy/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />l <br />I �C/�� — /� ne•H <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 />A/C — air handling units <br />_ <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <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 (service/bar/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 />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerility 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 and 86.200 WAC. <br />/Z� T`'!A //Z - 7-0 <br />Si nature of OwnenContractor/uthorized Agent Date v/2)l <br />