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PERMIT APPLICATIUN <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 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />II I b '74j 5+ SE. <br />G o7a3 zz <br />LEGAQ LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />grad. A,4Y-15U1 Z7-9o`{- 83r� PI I-' WA (g25)-7iS-/f70 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Vn C,"-r <br />I <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />0 — n.v <br />CONTR. LICENSE # 3-' P I L.J Ed/1 CUZS�'!"1 $- It') O <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric Gas Other <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Todel <br />A/C - air handling units <br />_ <br />Bath!ub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water healer <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />I <br />Clothes dryer <br />_ <br />Water heater <br />I <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/atc.) <br />_2� <br />Exhaust fan <br />_ <br />BeckOow preventer <br />_ <br />Heat pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />_ <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilily 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 />State Contractors Law 18.27 RCW and 296.200 WAC. <br />signature of owner/Contractor/AUlhodzedgent Date <br />�v <br />