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PtRMIT 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. # � <br />�7 o s <br />P RMIT # <br />� Zr <br />� �.� ' l <br />000t�.s3 <br />_ <br />LEGAL LOT NO. <br />BLOCK TRACT <br />DESC. <br />OWNER ADDRESS CITY2IP PHONE — <br />I'�-�^��a- `�cc,� 4-72_r� ��(,tw,-rd-/k✓c- Svc-r�-Fi- 6vx �8103 <br />TENANT NAME <br />CONTACT FOR PERMIT L{,Jes PHONE <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />CONTR. LICENSE p <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />_Electric _Gas _Other <br />WORK DESCRIPTION <br />141je,0 4., 6�( ash dy _ <br />PLUMBING <br />MECHANICAL <br />N0. TYPE OF FIXTURE OR ITEM <br />N0. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C —air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water healer <br />_ <br />_ <br />Kitchen sink &disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />BackBow preven:er <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <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 />ordinates 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 stale 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 />Slate Contractors Law 18.27 RCW and 296.200 WAC. / <br />Ct <br />1 ifI ]-'� O 6 <br />Signature of Owner/Contractor/Authorized Agent Date <br />��N <br />