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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 - wmAv.everettwal.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />P RMIT # <br />K � 4\U - <br />t' rcc-i,1�nC�O <br />LEGAL LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />M1LTotr 1 + u Kt' Lw- t',IL5 Ice, <br />TENANT NAME CONTACTr FOR PERMITPHONE <br />EMAIL <br />C NTRACT R AT6k SS CITYIZIP PHONE <br />CONTR. LICENSE # 7 4�JD <br />USE OF BUILDING /��AG� <br />HEAT SOURCE 1 <br />CONTRACT PRICE OF WORK <br />I , <br />•��C�Electric <br />_Gas_Other <br />•�;��j� [�.rN <br />T�C7 <br />WORK DESCRIPTION <br />�C-tL1 I�I.I•<�tfdJ�tcrn� a"-r� Ji D�r4C+�D G�+'�r� <br />PLUMBING <br />MECHANICAL <br />NO, TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />_ <br />Water healer <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />_ <br />Urinal <br />_ <br />Unit heater <br />Drinking Fountain <br />_ <br />Boiler <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodslove <br />_ <br />Roof drains <br />_ <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify 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 wet k will be complied with whether specified her^in 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 properly to perform the work for which application is made and I comply with the <br />Slate Contractors Law 8. CW arld'96.200 WAC. <br />)- q - 0 1 <br />Signature of OWndoo or Authorized Agent Date I r <br />fI l� <br />