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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 R AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 31Y -?d �0'/ S 4.-- Evls<r��►s� S'B1o) j�X803- 015 <br /> LEGAL LOT NO. BLOCK TRACTOR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> CNUcK r1,01W s 3!9 ?6 �WAcc SYS' EUl/lcJ'/ A00 &4eo3 1(0-7'tv <br /> TENANT NAME I CONTACT FOR PERMIT PHONE 10,6 ,j q,6 .71 <br /> 64.-yeslz E-MAIL <br /> (jWr ct4 �CJ� -A ZIB. W/y Sr.d ZZ2 K1AkL.4MU p? Lob• 39& •SYt <br /> CONTR.LICENSE# Q�alJ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other �800. o <br /> T <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—airhandlingunits <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> _ Shower Water heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clotheswasner Clothes dryer <br /> _ Water heater Range hood <br /> _ Sink(service/bar/mop/etc.) _ Exhaust fan <br /> _ Backflow prevenler _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> _ Floor drain _ Refrigeration <br /> _ Grease trap _ Woodslove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certify 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 aulhodzed by the owner of this property to perform the work for which application is made and I comply with the <br /> Slate Contractors LawjjU7 RCW AIM 290.200 WAC. <br /> Signature wner/Contractor/Authorized Agent Date <br />