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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 — wvmeverettwei.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -O <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />5 f- EvaRE !?/ 11? <br />LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />� <br />O(/L///liP/i //��-1Uh! � �%i��s �T 4��/x/eG %%U/i <br />TENANT NAME CONTACT FOR PERMIT PHONE yz «sy-goy/i <br />/ <br />04r EMAIL /'u'✓I.'rP OD <br />CONTRACTOR ADDRESS CITY/ZIP PHQNF <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />nn 5 <br />Electric Gas Other <br />I <br />I <br />WORK DESCRIPTION 64, {e. lle r - - n. ✓� �� Kf <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 />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />— <br />Water healer <br />_ <br />Kitchen sink & 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 />_ <br />Sink (service/bar!mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat 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 />Woodstove <br />_ <br />Roof drains <br />_ <br />Other_ <br />_ <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 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 296.200 WAC. <br />d4b <br />Signature of Owner/Contractor/Authorized Agent Date <br />