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PLRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.eveiettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />fql <br />PARCEL TAX I.D. # <br />P _ MIT # <br />6;0y3U30001767 <br />LEGAq LOTNO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER <br />ADDRESS CITY/ZIP PHONE <br />ICNA20 U1145oN <br />/9ll /: & ET��sy-5o / <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />S,e fit/ PMcj_/yam q2y-7-75-&c/Gcf <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />i,19{� d N/TE PGI�i�G� dfr /-ftT/r /&6/11 /5'aA09 0. 4 NIvalo /J tiL5-��5-G�l/eryr <br />CONTR. LICENSE # AAVN..zPH <br />egLt ctvL elo 637 <br />USE OF BUILDING <br />HEAT SOURCE <br />CON'RACT PRICE OF WORK <br />Electric AGas —Other <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and exam'ned 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 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 />Slate Contractors Law 18.27 RCW and 296.209-WAC. <br />Signature o Owner/Contractor/Authori d gent Date <br />