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PeERMIT APPLICATIUN S�as =07 <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 �7. �7Cf <br />425-257-8810 — FAX 425-257-8857 — www.everettNa.org 1 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PEFAIT # <br />LEGALL LOT NO. BLOCK TRACT <br />w�/(C(, <br />DESC. : UD - � O(1 /\v c1, /!(�K , ll� t <br />OWNERADDRESS PHONE <br />-761 <br />-��/7 d <br />TENANT NAME <br />CONTACT FOR PERMIT PIIJNE <br />PCITHONE <br />CONTRACTOR `/AAv SLy(k 143 SL)6 IA)( ADDRESSJJD ig0iV 13�V <br />IY�CT O <br />CONTR. LICENSE #, o z 1I-> <br />USE OF BUILDING <br />HEAT SOURCEC**ONTRACT <br />PRICE OF WORK <br />i I <br />_ Electric Gas _ Other <br />T, SU 9v v <br />WORK DESCRIPTION <br />•�,rU^ �£ /tilGiS�v✓' �rr�u,---/ }�Ga.-• � S cc...n�4- <br />/ <br />1— <br />PLLIM13ING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />3 <br />Toilet <br />_ <br />A/C - air handling units <br />I <br />Bathtub <br />! <br />Forced air systems <br />3 <br />Lavatory (wash basin) <br />Gas piping <br />% <br />Shower <br />1_ <br />Water heater <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />_L_ <br />Clothes dryer <br />Water heater <br />Range hood <br />Sink (service/bar/mop/etc.) <br />— <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heal pump <br />Urinal <br />_ <br />Unit heater <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />_ <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 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 tho owner of this property to perform the work for which application is made and I comply with the <br />Stale Conlraclts Law 18.27 RCW,R!� 296.200 WAC. <br />i <br />Signature of Owner/ nt 590Aulhorized Agent Date <br />