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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 —FAX 425-257-6857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERM M <br />LEGA LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION A <br />UESC. <br />OWNER ADDRESS CITYILP HONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Pjt.I1 cVo t rW 1 <br />r <br />`-� <br />*.:d E-MAIL .--r',ub'3..'• <br />. es Iry <br />CONTR. LICENSE <br />!,.4S6RP�PQ<8NG � r 3&0-54/Re14�¢ <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />O <br />Electric _Gas _Other <br />I <br />WORK DESCRIPTION Ltr.w,jLd fo, e e- Ctn rl c,; " n ! ' � iU <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />I <br />Toilet <br />A/C -air handling units <br />Bathtub <br />Forced air systems <br />� <br />Lavatory (wash basin) <br />_Gas <br />piping <br />I <br />Shower <br />Water heater <br />J_ <br />Kitchen sink &disposal <br />_Gas <br />fireplace <br />Dishwasher <br />_Gas <br />range <br />i <br />Clothes washer <br />_, <br />Clothes dryer <br />Water heater <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_Exhaust <br />fan <br />_ <br />Backflow preventer <br />Heat pump <br />_ <br />Urinal <br />_Unit <br />heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />W°°dsr'.ve <br />_ <br />_ <br />Roof drains <br />_Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE 19 7705 <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinances 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 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/Authonzed Agent �a— <br />