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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 — tnnvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />' PERMIT # <br />{1Jc ;.��L-� ✓f ��11<� . <br />I <br />L <br />II ,wUvon-ooci <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />_ <br />OWNER ADDRESS CITY/ZIP PHONE <br />/S/E ✓,�5,�;« lt�c r'V✓efi!-y.�kif'.izo( yz515��3_ <br />TENCAANT.. NAME <br />CONTACT FOR PERMIT PHON= <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />�r L!— <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />��✓�� 17.^-z-t��•� <br />�C' Electric _Gas _Other <br />WORK DESCRIPTION <br />/•*(SiAi.7"-/ <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 />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />/ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />/ <br />Gas range <br />_ <br />Clothes washer <br />/ <br />Clothes dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />Sink (servico/bar/mopletc.) <br />_Exhaust <br />fan <br />_ <br />Backtlow preventer <br />_Heal <br />pump <br />_ <br />Urinal <br />_Unit <br />healer <br />_ <br />Drinking Fountain <br />_Boiler <br />_ <br />Floor drain <br />_Refrigeration <br />_ <br />Grease trap <br />Waodstove <br />Roof drains <br />Other <br />Other <br />=I <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />hereby ceritity that I have read and examined this application and know it, , same to be true and correct. All provisions of laws and <br />ordinates governing This type of work will be complied with whether specifiud 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 L #z27 5SjW and 296.200 WAC. <br />igna a tractor/Authorized Agent ate <br />PERMIT <br />