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iivs 1 <br />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 <br />PARCEL TAX I.D. # <br />PERMIT # <br />LEGA LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY/LP PHONE <br />TENANT NAME <br />CONTACT FOR �PERMIT PHONE <br />E-MAIL CoQW ahgtJ( � C <br />CONTRACTOR <br />10�^'A0k\•\G'Rn ` CI11-115-341-Hll <br />CLCENS�# <br />�nIQS���N�.r1�3 Ub <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric Gas _ Other S 7 1 <br />I <br />WORK DESCRIPTION 7 O !o (u ( c,CCRC`P C C\lr <br />rA\C iv.CAs to t`\t E1o0f <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — airhandlingunits <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Water healer <br />Shower <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />_ <br />Dishwasher <br />Gas range <br />Clothes dryer <br />_ <br />Clothes washer <br />Water heater <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />Heat pump <br />_ <br />Backflow prevenler <br />Urinal <br />_ <br />_ <br />Unit heater <br />Drinking Fountain <br />Floor drain <br />_ <br />_ <br />Boiler <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />_ <br />Woodstove <br />Other <br />Roof drains <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />any other state or local law regulating construction or the performance of <br />to give authority to violate or cancel the provision 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 18.2 and2"O WAC. <br />w'�/Io <br />Signature of Owner/Contractor/Aut nzed Agent ate <br />M <br />