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PEN .MIT APPLICATION <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 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # I PERMIT # <br />5 <br />t o euak iqvS <br />_ �21 - <br />LEGAL LOTNO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />1512y✓4� ye, f< lblul 51, 3y3 "0 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />I <br />CONTRACTOR C�WNt`.L ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />V<15. rlc ` ( <br />—Electric ✓Gas _ Other <br />WORK^ DESCRIPTION <br />/ 1- <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />K tchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />Urinal <br />Unit healer <br />_ <br />Drinking Fountain <br />Bailer <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />✓ <br />Woodslove <br />Roof drains <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 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 state or local law reguiating construction of 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 —Contractors Law RRC�WW and 296.200 WAC. <br />/�1198.27 <br />,�_. ram!. - /VL- (G-Zi o1 <br />Signalu'e of Owner/Contractor/Authorized Agent Date <br />