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PERMIT APPLICATIVN <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 4% 9b z Q b PARCEL TAX I.D. # PERMIT # <br />tc;, <br />LEGA LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS CITY21 NE <br />y v-6y <br />b't7fciil k'. URZik '( �/ 5" <br />TENANTNAME <br />I CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITy21P PHONE <br />�ynnwoc�r 90��3y <br />CONTR. LICENSE # 1 <br />c:,/1sP1A/L1'7f /54°15Ac1►t1irzt1h/ ua2(/-A /2-39PC <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I — Electric Gas Other <br />I <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — airhandlingunits <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />_ <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (servicelbar/mopletc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boller <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodslove <br />_ <br />Roof drains <br />Other_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify 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 [his 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 l�aulhorized by the owner of this property to perform the work for which application Is made and 1 comply with the <br />Slate rac1orIsLaw 18.27 RCW itv96.200 WAC. <br />gnature of Owner ntractor ut orize gent Date <br />