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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 93201 <br />425-257-8810 - FAX 425-257-8857 - www.everetfwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM Y —V <br />SIITTE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIYT�P <br />tt ')L1`1 -3-%-" P.�C lY� <br />J <br />/7Jj II-7CTU jd 11 CCU <br />vY\ <br />rNO' <br />LEGA LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />E-MAIL <br />CONTRACTOR ADDRESS CITYIZIP BONE <br />CONTR. LICENSE # <br />lY <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />_ Electric = Gas _ Other <br />WORK DESCRIPTION UU¢wv�j w�f (-c'J 42r :Jlt1L %tr'w— �Lu0 TL' �'e <br />C�rCr3tif Cad �uCl(t✓lS �h Ci Vwr��� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other �r.it✓ titGc' <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Wo �r heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Beat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />-- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br />1 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 ermit does not presume <br />to live authority to violate or cancel the provision of any other state or local law regulating construction or the I. %formance of <br />construction. That I am authorized by the owner of this property to perform the work fc which application is mao, and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />20 ID <br />Signature of Owner/Contractor/Authorized Agent Dale <br />-- <br />