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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.ev�rettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM 10 4 PM <br />SITE ADDRESS I PARCEL TAX I.D. # PERMIT # <br />LEGAL LOT NO. BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS PRONE <br />QQC,,I�.Y21P <br />P� jq n 'F:-7L cz � 7� /G i/1lC �06n5 !�/1r.0 r�Lyy /.�•;v'F�jcyt./ I�Q � ' U <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />j.� i��G'�' �/�h'CiF 5irZlTf i�St>3/ •ibv-• 'ii65/G <br />CONTRACTOR`ADDRESS CIrY21P PHONE <br />�1�5�%�/'-k7o/ <br />f/�.1 C-Kyir.,��c /�G:F r%�• %�iJ1U <br />CONTR. LICENSE # i � ., <br />/�riL?i=�/oliyDf� 3 30`/ <br />USE OF BUILDING <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />G� <br />%'IL'G%'Si?�.�' SII; x7C / <br />,(xbeclric —Gas Other �^ <br />— ,�'i % �y• P�[7 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />NC —air handling units <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />_Gas <br />piping <br />Shower <br />Water hector <br />_ <br />Kitchen sink &disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />_Exhaust <br />fan <br />_ <br />Backfluw prevenler <br />Heat pump <br />Urinal <br />Unit healer <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Wooaslove <br />Roo 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 />ordinaces governing this typo 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 stab or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of [his property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW,4rtd 290.200 WAC. <br />/Signah-e of O% r/ ontractor/AuUrcnzed Agent Dare r <br />