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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.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />LEGAL LOT NO. RLOC11 TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />P6vL VWW ,6691 q7S b <br />CONTRACTOR ADDRESS CITYMP PHONE <br />CONTR. LICENSE 4 <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />o /y� va <br />l�4-� _Electric VGas_Other golly <br />WORK DESCRIPTION i��ull J S �/YAQQC) pins VingJe, RAJ 5AS O'�in�l R25i.<li(UCk <br />L�Clro�^5 �OvS-�, J I <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ Toilet <br />_ Bathtub <br />_ Lavatory (wash basin) <br />_ Shower <br />_ Kitchen sink 8 disposal <br />_ Dishwasher <br />_ Clothes washer <br />_ Water heater <br />_ Sink (service/bar/mop/etc.) <br />_ Backflow preventer <br />_ Urinal <br />_ Drinking Fountain <br />_ Floor drain <br />_ Grease trap <br />_ Roof drains <br />Other <br />NO, I TYPE- OF FIXTURE OR ITEM <br />A/C — air handling units <br />= <br />Forced air systems <br />Gas piping <br />Water heater <br />_ <br />Gas fireplace <br />Gas range <br />_ <br />Clothes dryer <br />_ <br />Range hood <br />_ <br />Exhaust fan <br />_ <br />Heat pump <br />Unit heater <br />_ <br />_ <br />Boiler <br />_ <br />Refrigeration <br />Woodstove <br />_ <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 Claws 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 slate 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 8.27 RCW and 296.200 WAC. <br />a zz zU46 <br />Signature of OwnerlCo c r/Authorized Agent Dat — i <br />