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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 V ogD2• T� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> v` W- 31 <br /> LEGAL LOT N0. BLOC TR T <br /> DESC. r. / (�r <br /> OWNER k IlWf) bl:,,�J)(() AD 8 21P PHONE <br /> �!;r�'' �1ii P) clfl( s BouLl33 Shl)oim+sh 9�'��il �425)2�1-P733 <br /> TENANT NAME CONTACT FOR PERMIT / PHONE <br /> CONTRACTOR -�tn�t�' E1�ruuQ� /q % ; ADDRESS �u/b Lk Of CITY/Zip PHONE <br /> LV <br /> CONTR.LICENSE IS- V <br /> IeFWABf�d'973A�S` <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric _Gas_Other �' <br /> WORK DESCRIPTION <br /> .1'ildei <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 Z Forced air systems <br /> 1� Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> L Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray L Range hood <br /> Sink(service/bar/mop/etc.) Exhaust tan <br /> _ Backflow proventer Heal 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 coritify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified hereln or not.The granting of a permit 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 /> Slate Contractors Law 18.27 RCW and 290.200 WAC. <br /> S B alure of Owner/Contractor/Authorized Agent Date <br />