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PUMIT APPLICATIO,J <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 AkE ACCEPTED FROM 8 AM TO 4 PM - Dr-BIT& CREDIT CARDS ARE NOT ACCEPTED <br /> I <br /> SITE ADDRESS PARCEL TAX I.D.# MIT# <br /> 30ic (op'`' S4 . s•i�. <br /> 00S4Int —ODD-001 . 03 <br /> LEGALL LOT NO. BLOCK TRACT <br /> DESC. <br /> O��W//NER JJ 11 '^1 I ADDRESS CITIY2IP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Vl�(-ANT I I`oA Vocn (- Nzs) 239 -492` <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE 0 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other <br /> WORK DESCRIPTION n <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Tollet A/C—air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> _ Shower Water healer <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/bar/mop/etc.) _ Exhaust fan <br /> _ Backftow preventer _ Heal pump <br /> _ Urinal Unit heater <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 3105 <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 /> ordinaces 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 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 Contractgrs Law 18.27 RCW and 296.200 WAC. <br /> I- nI� l70 <br /> Signatu—re ofZSivner ontractor/ ut onzec Agent Date <br />