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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.# PERFAIT# <br /> •3ot &o44 Pi- s4-�7 <br /> LEGALOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> P),Ce vctl Alee(4 3Z7,f bo{/11)/ SE CV�t''q- ` V2i)3 425"3s3 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR M-c%ae( !Vee( (A4me�+tu)ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE N <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORKDESCRIPTION �e�(gteMt t �� W OrQ �tTa: rW , Lr.fr7 �e vS �c t:�-1 h� sw <br /> LJ '-44A SI"ce( «..d G+..c,neYe St-r• rw�-.J. , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet _ A/C—air handling units <br /> _ Bathtub _ Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> _ Shower Water heater <br /> _ Kitchen sink 8 disposal _ Gas fireplace <br /> _ Dishwasher _ Gas range <br /> _ Clothes warier _ Clothes dryer <br /> _ Water heater _ Range hood <br /> _ Sink (service/bar/mop/etc.) Exhaust fan <br /> _ Backfiow preventer Heat pump <br /> _ Urinal Unit healer <br /> _ Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> 1 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 /> ordinecos governing this typo of work will be complied with whether specified herein or not.The granting of a porrmil does not presume <br /> to give authority to violate or cancel the provision of any other stale 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 298.200 WAC. <br /> �� C''Z <br /> Signature of Owner/Contractor/Autho d Agent Date <br />