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PcRMIT APPLICATIVN <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 <br />PARCEL TAX I.D. # <br />P MI R,, <br />�# <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. [-5 <br />OWNER ADDRESS CITY2IP PHONE <br />1�4NAlyAN NCn(�(erJ Vq23 36 Df. W -4zs--7S3-IS <br />TENANT NAME <br />ONTAC/T FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric � Gas Other <br />WORK DESCRIPTION <br />I q X Ala X� <br />11 ll �! <br />1TJYY <br />LIL�CLI . I� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE CR ITEM <br />jk. <br />Toilet <br />A/C —air handling units <br />'2 <br />Bathtub <br />_Forced <br />air systems <br />Lavatory (wash basin) <br />_Gas <br />piping <br />J_ <br />Shower <br />Water healer <br />-� <br />Kitchen sink &disposal <br />i <br />Gas fireplace <br />Dishwasher <br />� <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Water heater <br />� <br />Range hood D V <br />_ <br />Sink (service/bar/mop/etc.) <br />� <br />Exhaust (an <br />_ <br />BackBow provenler <br />Heal pump <br />Urinal <br />Unit healer <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />7 <br />Refrigeration <br />_ <br />Grease Trap <br />Woodslovo <br />Roof drains <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />hereby corilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinacos 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 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 />Stale Contractors Law 18.27 RCW and 298.200 WAC. <br />O <br />Signature o Ownor/Con recto /Au on ed Agent Dale t'L <br />