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PERMIT APPLICATIVN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98?01 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />'N�e <br />PARCEL TAX I.D. # <br />� <br />P RMI / <br />170� <br />(B'3 ! � hE � <br />�� 5 3 z 3 � 5� 1 <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE 41-2 5 <br />3 z z <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE ( � Ll G (V <br />7 0 <br />S,'TAvVL� <br />E-MAIL <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT FRICE OF WORK <br />Electric Gas _ Other <br />WORK DESCRIPTION <br />f�I:;�)OLAcIr- <br />j,-j D 27- c_ L 4::, Srti <br />ern to-Cr;- /� --r (C, w p �S I <br />7 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 />I <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes drier <br />_ <br />Water heater <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit healer <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <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 />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 a_.horily 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.and 296.200 WAC. <br />U <br />of Owner/CentractoriAuth zed Ap t Date <br />L <br />r <br />