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Pr. MIT APPLICRTIGN <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 3 _ I I —'09 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />U <br />8J : r. Xifurta <br />_� <br />LEGAL LOT NO. <br />LOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS Cl 11ZIP PHONE <br />r ,F /.� � �Fi1N feN T r%y Lr X n- vr..�� ✓-•�-j• t'✓: y (' z c /� � Z r l t� / J <br />TENANT NAME <br />I CONTACT FOR PERMIT PHONE <br />E-MAIL <br />C—O�GTf?jR ADD ES ITYIZI H HE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />C-Ic�rric _Gas _Other <br />WORK DESCRIPTION <br />// <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM I NO. TYPE OF FIXTURE OR ITEM <br />J <br />Toilet <br />_ <br />A/C — air handling units <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />_ <br />Water healer <br />Kitchen sink & disposal <br />— <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gasrange <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water healer <br />— <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />— <br />Heat pump <br />_ <br />Urinal <br />_ <br />Unit heater <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />Floor drain <br />__ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodslove <br />_ <br />Roof drains <br />Other <br />_ <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and e%amined 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 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 />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />