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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 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />ER�t1, <br />s � d � <br />lryro OdSr': S.� �ii'rl► ✓d <br />O <br />LEOA LOT NO. <br />BLOCK <br />TRACTOR Sla901VISI0NN <br />DESC. <br />OWNER ADDRESS CITY2IP PHONE <br />T/EN�A�NT NAME FOR PERMIT PHONE <br />n /CONTACT <br />L/J• 7-1-YJro \9c� I /\ 41 EMAIL IF1a/D�f �4/O/I�r1�SG[ <br />W.. .�J ���/'- 1 i;� pry->A.�s�.�io� lli,•� cw� (3-gi��3S 6�S <br />M <br />� <br />CONTR. LICENSE N <br />1*4 1-7? M1 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I <br />_Electric Gas Other <br />0 <br />0 v60, o <br />WORK DESCRIPTION - <br />PLUMBING MECHANICAL <br />N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />_Gas <br />piping <br />Shower <br />Water heater <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryor <br />_ <br />Water heater <br />_Range <br />hood <br />_ <br />Sink (servlca/bar/moplotc.) <br />Exhaust Ian <br />_ <br />Backllow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grosse Trap <br />Woodstove <br />_ <br />_ <br />Roof drains <br />_Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby corilily 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 typo of work will be complied with whether specified herein or not. The granting of a permit dons not presume <br />to give authority to violate or canto/ the provision of any other stab 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 10.27 RCW and 296.200 WAC. <br />s/ay/fls' <br />Signature of Owner/Contractor/Authorized gent ate <br />