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t <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9�201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS r^ II/ <br />PARCEL TAX I.D. # <br />PERMIT # <br />LEGAL] LOT NO. <br />BLOCK <br />TRACT <br />DESCT, <br />OWNER ADDRESS CITYIZIP PHONE <br />I' <br />K r <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />"i IAzct" GAr,IF_'Go5 <br />ll'k-10 6AfLEC,c6 (yzs) Soo- 33 11) <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />�_ 5 !]d/'SC�O <br />Electric _Gas _Other <br />— <br />WORK DESCRIPTION( <br />OCCJIcv, O� CS�(C-sT_O (;4ea' j <br />PLUMBING <br />MECHANICAL <br />NO. TYPE Or. FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (war.n basin) <br />_ <br />_ <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Shower <br />Kitchen sin& & disposal <br />Dishwashor <br />Clothes Hasher <br />Water heater <br />2:S:_ <br />_ <br />_ <br />_ <br />_ <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />_ <br />_ <br />_ <br />' <br />Sink (set vice/bar/mop/eta) <br />Backflo%v prevenler <br />Urinal <br />_ <br />_ <br />Exhaust fan <br />Heal pump <br />Unit heater <br />_ <br />Drinkin I Fountain <br />Floor -'min <br />Greas3Vap <br />Roof drains <br />Other <br />'�K <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />_ <br />_ <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 0105 <br />1 hereby ceri ify tnat I have read and examined this application and know the same to be true and correct. All provisions of 11ws and <br />ordinates gcveming this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give audit rity 16vfolate or cancel the provision of any other state or local law regulating construction or the performance of <br />constructi R Th t I am authorized by the owner of lhi; property to perfoml the work for which application is made and I comply with the <br />Staid Co tr ^tors Law)8.27 RCW and 296.200 WAC. <br />7t LC <br />Signature of ,N�� ontractor/Authorized Agent Date <br />I�} <br />