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PERMIT 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 <br />SITE ADDRESS /) (Jar /` <br />lJ l <br />^ „PARCEL TAX I.D. # <br />PERMIT — <br />LEGA LOT NO. <br />BLOCK <br />TRyIA..CNVTL <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />4 64any l � ao - <<0 . Gb-6—. <br />TENANT NAME CONTACT FORPERMIT PHONE <br />I U S� �2s a70 2�L <br />' CITY/ZIP PHONE <br />CONTRACTOR I r �� <br />�� SQADDRESS <br />CONTR.LICENSE # , In�C J � 0-2/ t) <br />.J <br />USE OF BUILDING <br />I HEAT SOURCE <br />ZGas <br />CONTRACT PRICE OF WORK <br />S[2 <br />leclrc _Other <br />b <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 />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />_ <br />Water healer <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />_ <br />Unit healer <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodslove <br />_ <br />Roof drains <br />_ <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of lar+s 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) am authorized by the owner of INS property to perform the work for which application is made and I comply with the <br />18.27 R W 298.200 <br />State ConlractgrdLaw and <br />_ <br />$i�q{1 lure of OwnerlQ ntraclor/Aul orized Agent Date <br />