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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8610 -FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS / <br />PARCEL TAX I.D. N <br />PERMIT # <br />LEGA LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION N <br />DESC. <br />OWNER ADDRESS CITYZIP PHONE <br />13qi'ln Le%,.,o,n&1C�•vJski 21Zb w,ln',l-s#- <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />E-MAIL <br />CONTR. LICENSE N <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WS&K <br />�; <br />_Electric _Gas _Other <br />WORK DESCRIPTION <br />Ne,,j Lx::-� t0-11+-�,,�Y,9 C �e, r�IsU 54ti� <br />J r r iCR��RC.P <br />- PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C —air handling units <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />I <br />Gas piping <br />_ <br />Shower <br />Water heater <br />Kitchen sink &disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />_Clothes <br />dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (service/barlmop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />—Heat <br />pump <br />_ <br />Urinal <br />_Unit <br />heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />_ <br />Roof drains <br />Other <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 0105 <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinances 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 state 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 torwhich application is made and I comply with the <br />fate Contractors Law 18.27,RCW and 296.200 WAC. ; <br />Signature of Owner/ContrActorlAuthorized Agent D to <br />