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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS <br />ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />v115 <br />PARCEL TAX I.D. 0 <br />00 S6 79 -1701 -00-OS <br />R `MIT <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />S <br />DESC. <br />I <br />_'LVICw <br />OWNER <br />.Rr ADDRESS CITY/ZIP PHONE <br />John �-(-` s �)P &C �/ l=-el-eN��b'-0 �t�S ;s3-2Y <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR <br />ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE 11 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />�ZsI�IC It T/nI <br />_ Electric _ Gas_ Other <br />_ <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE <br />OF FIXTURE OR ITEM <br />NO. 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 />I <br />Gas piping <br />_ <br />Shower <br />I <br />Water heater <br />_ <br />Krchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/barhnop/etc.) <br />— <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />_ <br />Boiier <br />Floor drain <br />_ <br />Refrigeration <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <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 />ordinates governing this <br />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 cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am <br />orized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors La <br />7 RCW and 296.200 WAC. <br />1)le /A�t <br />Signature of Owner/ n <br />o uthorized Agent Date <br />