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PEkMIT 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 /1 <br />2�7G'/ �l/� <br />PARCEL TAX I.D.1t <br />PERMIT #(/ <br />07 j <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />UESC. <br />OWNER ADDRESS CITY2� PHONE <br />T��SlC ILI//7GI7�w s' Zn4:Qv>: �Y9SzO9 `/27'-339-36z <br />,S6o7 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />61;f4 E-MAIL <br />CONTRACTOR ----ZDRESS C TYI''ZI�' PHONE <br />-?7 <br />5r-,vice (. J�0 / <br />7- j <br />CONTR. LICENSE / <br />oyz KZ �vP <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />/if� <br />Electric _Gas _Other <br />WORK DESCRIPTION / h / f �`�� � <br />I f <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 />_Gas <br />piping <br />_ <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 healer <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />� <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstovo <br />_ <br />_ <br />Roof drains <br />Other <br />Other <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 />ordinaces 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 slab 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 296.200 WAC. <br />Signature OwnerlC6n ractor ulhodzed Agent Date <br />