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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 -vrww.everet(wa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDREPS O PARCEL TAX I.D. p PERMIT 0O / r <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNE5 ADDRESSCI1�!/•,n e`PHONE <br /> GLi//$ ti /�o.�. <br /> /�wa. <br /> TENANT NAME d CONTACT FOR PERMIT / PHONE <br /> �•c!•t 'l�y MQuOr /�/ I l (,C/d/!//`!t�' 721' <br /> E-MAIL <br /> CONTRACTORCITY/ZIP PHONE <br /> `�Jfr^'e <br /> CONT6.LICENSER ThC <br /> �Y49N5SOy2k2 FyY 987v/ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> A �S Off' <br /> `�•i1'( /� �5 Y Electric _Gas—Other /cl!/Q <br /> WORK DESCRIPTION / <br /> PLUMBING MECHANICAL <br /> NO. TYPL= OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITE0 <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 washer Clothes dryer <br /> Water heater _ Range hood <br /> _ <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> _ Backftow pr wenter __ Heat pump <br /> Urinal _ Unit heater <br /> _ Ddnl•ing Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trap _ Woodstove <br /> _ Roof dralns Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby eeritify that I have read and examined this application and kno a 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 state 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 Conlractorq4iaw 18.27 R W and 290.200 WAC. <br /> /Y 3- <br /> Date <br /> Signatur o wner/Con ractorl Uthorized gent <br />