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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # P RMIT # <br />�,5 offfLEGAL <br />LOT NO. TRACT <br />n1tOCK <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />1 ;cky V. h!LA LC <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR L',J NSIP ADDRES9 CITYIZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Sf k I <br />_ Electric _ Gas _ Other <br />WORK DESCRIPTION �, fcl�ta co�c AJt,✓A2PoR <br />ay X <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air h ndrmg units <br />_ <br />Bathtub <br />)e <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />X <br />Gas piping <br />_ <br />Shower <br />>( <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />_ <br />Range hood <br />Sink(service/barlmop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow prevenler <br />_ <br />Heal pump <br />_ <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 />_ <br />Woodslove <br />_ <br />Roof drains <br />— <br />Other <br />_ <br />Other <br />— <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 peril does not presume <br />to give authority to violate or cancel the provision of any other slate 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 />Stal nlractors Law 18.27 R Wand 296.20G WAC. <br />Sign tur Owner/Contractor/Authorized Aoent Date <br />