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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 95201 <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 />PARCEL TAX I.D. # <br />PERMIT # <br />1 L' `/ �l `/��e.'<«)rt �� , -✓C <br />Yf/S "-•i/ �C,$- fl-OG: <br />C 7(,1)L -C>33 <br />LEGAL LOT NO. v <br />BLOCK <br />TRACT <br />DE SC <br />OWNER ADDRESS CITYIZIP PHONE <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />7f <br />CONTRACTOR P0lZcfj,4,1J CcwdsTn-a0,4 ADDRESS CITYIZIP PHONE <br />1 I'z 1-1 3 9 T>, DR 5E E V'F_k C7r <br />:ONTR. LICENSE # <br />MoRc rAC-19scU2 [ g/zl1UJ <br />USE OF BUILDING <br />HEAT SOURC <br />C t'CE b1 -WO RK <br />/�r3 of LfC- <br />_Electric ✓Gas_Olher <br />6�+prow '§ 105-i 491�r1'0D <br />WORK DESCRIPTION A ' X 3G ' er fd'�+ Spayx r.•� e�f e e i sT.✓y <br />FvefXACci FaA—AtOVrTrcrl -ry piee IivjMLz_c^n r11 6A I-jeAl <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 />L <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />BackBow preventer <br />Heal pump <br />_ <br />Urinal <br />Unit healer <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 />i <br />CITY Of EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 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 stale 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�296.200 WAC. <br />��.� ' — C, <br />Signature of Owner/Contractor/Authorized Agent Date ( Z <br />