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PAIMIT APPLICATICL <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evere:twa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />!CtZr"till A7J-k&AIK&' <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR L-c= / /' ADDRESS 114,.v 5'L" CITYIZIP PHONE <br />CI) <br />Otct4cro <br />CONTR. LICENSE # ,y <br />Z0,1 L1�3V ��fSIZ� 01"-- 7 <br />USE OF BUILDING <br />HEAT SOURCE <br />I CONTRACT PRICE OF WORK <br />Electric _ Gas Other <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />Z <br />Bathtub <br />Forced air systems <br />f <br />Lavatory (wash basin) <br />Gas piping <br />z <br />Shower <br />Water heater <br />Kitchen sink & disposal <br />Gas fireplace <br />L <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />_ <br />Range hood <br />_ <br />Sink (service/bar/mopietc.) <br />Exhaust fan <br />Backflow preventer <br />Heat pump <br />iUrinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />Roof arains <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 />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 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 />Signa[u or Owners ontractouAuthonzed Agent Date � <br />