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APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 •- FAX 425-257-8857 — vWvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. p <br />PERMIT # <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP <br />I Q lo �. I - l��l I��l ��v2JC�41 PHONE <br />/ y� / g ^ <br />J I q / <br />TENANT NAME <br />FOR PERMIT PHONE <br />�OQ \� <br />[. 34,° -3 I i Uzi `� <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />C� <br />Gas Other <br />6 <br />- O� <br />—1011Viet, <br />_Electric _2!L _ <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 />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />� <br />Gas piping <br />Shower <br />Water healer <br />_ <br />Kitchen sink &disposal <br />� <br />Gas fireplace <br />_ <br />Dishwasher <br />___)L <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water healer <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 healer <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease Trap <br />Woodstg9yye <br />Roof drains <br />� <br />Other v <br />Other <br />�.i+�<✓ rt'1"'v�. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br />I hereby ceriti(y 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 a horized by the owner of this property to perform the work for which application is made and I comply with the <br />Stat ntractors L .18 7 RCW and 296.200 WAC. <br />/ l 3o D �q <br />�. <br />Signature of vner/Co Ir or/Authorized Agent D� le <br />PERMIT <br />