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P6MIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257.3857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO PM -7` a,3.-07 <br />SITE ADDRESS <br />PARCEL TAX I.D. If PE MIT 0 <br />LEGAL LOT NO. n <br />DESC. <br />BLOC;< <br />TRACT <br />, C� //J� _ <br />—c)7 <br />V / Ins <br />OWNER ADDRESS CITYIZIP PHONE <br />I - \ 1 l <� I✓• C `. ` n r � M R,_(_l - !{ �o (n) I S Q ! 1 V- �'� (. � f • J S <br />_ <br />TENANT NAME <br />CONTACT FCR PERMIT PHONE <br />T— <br />CONTRACTr- ADDRESS <br />7 (}, CITY/ZIP PHONE <br />CONTR. LICENSEp ����(�it .1 `���LF �� • �• <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />C- 1 � I <br />_ Electric X Gas Other <br />WORK DESCRIPTION <br />VIM, <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilot I 1 <br />A/C — air handling units <br />Bathtub I 1 <br />Forced air systems <br />Lavatory(wash basin) Ill <br />„$ <br />Gas piping <br />Shower <br />_ <br />Water heater <br />I <br />Kitchen sink 8 disposal <br />I <br />Gas fireplace <br />I <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer I% <br />I <br />Clothes dryer <br />_ <br />Water healer_ <br />Range hood <br />_A._ <br />Sink (servico/bar/mop/etc.) I <br />Exhaust fan 111, I <br />_ <br />BackBow proventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />D•inking Fountain <br />Boller <br />Floor drain <br />Refrigeration <br />_ <br />Grease Uap <br />Woodslove <br />_ <br />Roof drains <br />Other <br />Other <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify that I have read and examined this application and know 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 parterre the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />y <br />Signature of Owner1Cdnlractor Od28 9n1 Dato t/ <br />:Stec 5 s-5 ydz0& <br />