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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-3810 — FAX 425-257-8857 — www.everettwa.org <br />—S L APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />a Sa ate oo��-CJl <br />LEGAL LOT NO. BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />&p�i�e �/Gc ;�/� o2Q/O :I I '--7- ylS' 2S9 S4/9- <br />TENANTT NAME <br />CONTACT FOR PERMIT PHONE 2 S a:� _ 5 f l 6� <br />EMAIL <br />CONTRACTOR ADD IP PHONE <br />CONTR. LICENSE # �� J <br />USE OF BUILDING <br />I HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />("�fw <br />Electric _ Gas Other <br />WORK DESCRIPTION <br />0 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water healer <br />_ <br />_ <br />Kitchen sink & oisposal <br />Dishwasher <br />__ <br />Gas fireplace <br />Gas range <br />_ <br />Clothes washy <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />_ <br />Sink (service/b mop/e(c.) <br />Exhaust f <br />_ <br />Backflow pre nter <br />Heat pump <br />Unit heater <br />_Urinal <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Wooastove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify 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 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 mad^ and I comply with the <br />Stale Contrad Law 16.27 RC1N,a6d 296.200 WAC. <br />66 h 0ollil <br />t <br />Signature of Own C9 lraclo thorized Agent Date <br />t/� <br />