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PL.RRIIT APPLICATKA <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEPETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PE-RM1T # <br />.— <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC, <br />OWNER <br />ADDRESS CITYIZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR <br />ADDRESS CITY/ZIP PHONE <br />Cn/if{r ay lin.f <br />7ov/ /�s•./si iV<. `/7.C-275-689Y <br />CONTR. LICENSE # <br />s-a , <br />USE OF BUILDING <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric Gas Other <br />_ _ <br />15' o dd. <br />WORK DESCRIPTION <br />Rr n...� a.,i✓ rr 6..'/a/ <br />-r'ria A/.//t , :-� S7e // 3 d/rl;ea?0- / / <br />d <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE <br />OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />AIC - air handling units <br />_ <br />Bathtub <br />Forced air systems <br />= <br />Lavatory (wash basin) <br />/, � <br />Y <br />Gas piping <br />Water healer <br />_ <br />Kitchen <br />Kitchenn sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/barhnop/etc.) <br />Exhaust fan <br />_ <br />Backflow prevenler <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />1 hereby ceritify that I have read <br />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. i-he 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 authoHz d by the owner of this property to perform the work for which application is made and I comply with the <br />Stale Conlrac rytaw 18.2 <br />C and 296.200 WAC. <br />/ <br />Co//6 > <br />gna ure of Owner/mittrai7oiTAuthorized <br />Agont Date <br />t/Z <br />