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PLAMIT APPLICATIGA <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — Www.everettwa.crg r�.� O /�/ ` al p <br />LG <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 "'M - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.U. # / <br />PERMIT # <br />// / 03 & <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />j �� <br />/ J � LolcC 6yy_ e 4Y25 33�6 4LAM0 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />M,64-AeI aAW_ 'k _ q23- 363 G�YSc% <br />CONTRACTOR LC-hV-LJ ADDRESS ,515_ -7 :�j7 CITY/ZIP PHONE <br />t�tf yzs 3s3-&KSv <br />CONTR. LICENSE # �:� j�O �'�� � �� <br />`) <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />X Electric Gas Other <br />c+ <br />��•� <br />WORK DESCRIPTION _ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />_ <br />A/C —air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow prevenler <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodslove <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 t•ue and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or no'.. The granting of a permit does not presume <br />to give authority to violate or cancel he provision of any other slate or local law regulating construction or the performance of <br />construction T4atI m uthoi y the owner of this property to perform the work for which application is made and I comply with the <br />Slate Cor)t c rs aw 8.2` and 296.200 WAC. <br />Signature of Owner/tractor/Authorized Agent Date <br />