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Pr.RMIT APPLICATIGN <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 PIM <br />SITE ADDRESS / , <br />PARCEL TAX I.D. # <br />PERMIT # <br />v /5�� <br />UO('UGSUUOUtg0o <br />LEGAL LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION # �. _ <br />IVl jlo •.J <br />DESC. I �T <br />U0Ev ���(�E <br />OWNER ADDRESS CITY/ZIP PHONE iy 2 S <br />ti <br />/ \ r) ice' J is l lI Gt/ i �S o.✓ q 61 `, i /n I 6--L) c cW q').03 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE/--3 Lit <br />E-MAIL <br />R A DR SSCITY/ZIP PH <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric _ Gas _K Other <br />I <br />f+ <br />WORK DESCRIPTION !1 IC( tq 1 C. <br />94 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — airhandlingunits <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />— <br />Gas piping <br />_ <br />Shower <br />_ <br />Wdler heater <br />_ <br />Kitchen sink 8 disposal <br />— <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />_ <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />— <br />Exhaust fan <br />_ <br />BackBow preventer <br />— <br />Heat pump <br />_ <br />Urinal <br />_ <br />Unit heater <br />Drinking Fountain <br />— <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Roof drains <br />Woodstove <br />Other_rOe�ie� S�avE <br />_ <br />Other _ <br />— <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 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 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 CgOtractors Law 18.27 RCW and 296.200 WAC. <br />^ <br />Signature of Owner/Contractor/Authorized Agent mate <br />