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IcRMIT APPLICATi.1N <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 1 Z ... 3 — p9 <br />SITE ADDRESS <br />PARCEL TAX I.D. M <br />PERMIT N <br />LEGAL LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION p <br />DESK. <br />OWNER ADDRESS CITY2IP PHONE <br />CA2(.ci LH1-�✓u,u CLJ�0 .2 q LU (oZr�1 Sri S L <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />6il JC/11cv--1 I/1� 3`G S o EMAILf <br />CONTR. LICENSE(c-:- ti - IJ 4 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I — EIccIFc Gas Other <br />� 3C-<) <br />WORK DESCRIPTION HT C/K LIP P-q T L FN iM C-r`f� GcAJDQIi� <br />PLUMBING <br />MECHANICAL <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />NO, <br />TYPE OF FIXTURE. OR ITEM <br />Toilet <br />A/C -air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />� <br />Gas piping <br />Water heater <br />_Shower <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clulhes washar <br />Clothes dryor <br />_ <br />Water heater <br />Range hood <br />_ <br />_ <br />Sink (servicoNar/mop/olc.) <br />Exhaust tan <br />_ <br />8ackflow prevenlor <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodslovo <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby ceritily That I have road and examined This application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this typo 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 rancol the provision of any other state or local law regulating construction or the performance of <br />construction. That I amhorized by the owner of this property to perform the work for which application is made and I comply with the <br />Slate Cdnlractors Law,1 27 RCW and 200.200 WAC. <br />Si alure of Owner/Contractor/Authorized Agent Dale <br />