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PE,IMIT APPLICATIO14 <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8310 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />! <br />.TO l� a l S'sr �Uel" fT% 00'5-y/0 005 00 I XO`1D8-Oo% <br />— <br />O. BL <br />LEGAL LOT NOCK TRACT <br />DESC. <br />OWNER ADDRESS CITy1ZIP PHONE <br />O&SUPA/Y ! cAkAff&rE rAytvr4 �0i0 1_e SSI' E!/�,FFTr lciA 1?zo! yzsz�'9 9o�i7 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />L <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I — Electric Gas Other <br />I <br />WORK DESCRIPTION <br />P,£/,la(/t< GAUNr),d,' vi /Lf7� �ODit1 <br />1)4t joeAfE clpil h1 6$ [!l<dV FP/ARf�ER <br />i612- WE 7'"E d < r-lc9iei/ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />j <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Bailer <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />L <br />Roof drains <br />Other [&)1"k"R F4EA1k=/Q <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 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 made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Si nature of Owner/C niractor/Authorized Agent Date <br />