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PeRMIT FVPUCATIUN <br />PeRMIT APPLICATION <br />*z or e�eeenreem�rse ices <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 S AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAY. I.D. # <br />PERMIT p <br />LEGAL �i TNO. � <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY2IP PHONE <br />,J <br />'%�,0//]V�4''/�P'� O7U/q 1/!'7 ili(w, /1Y Z�rJPl'P.f/- 2'>7{J/ �i� - <br />TENANT NAME <br />CONTACJ FOR PERMIT PHONE <br />YY / <br />CONTRACTOR %p1p � « - C Yq®pRESS CITY2IP PHONE <br />CONTR. LICENSE p <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Nf5�1r�1 <br />Electric � Gas _Other <br />WORK DESCRIPTION ('as <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/, —air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_g_ <br />Gas piping <br />_ <br />Shower <br />Water healer <br />Kitchen sink &disposal <br />Gas fireplace (SA.-C% <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Water heater <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow prevenler <br />Heal pump <br />Urinal <br />Unit healer <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodslove <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <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 />ordinates governing this type of wort; 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 aulhcrizad by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />/1 l / <br />L/ <br />I��'� • llO %2�c 5 <br />Signature of Owner/Contractor/Authorized Agent at <br />J <br />