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PcRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 —FAX 425-257-8857 — www.everettiva.org <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />W�, Sy 1\c I �, 'L-- `1 C'� \- L �t C-v#-WA1, 11b2oF 1y2&5;-4 `', 3 -0-IU j <br />/ <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />I <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />r <br />Electric Gas Other <br />— — <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Tailor <br />A/C —air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />� <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />_Gas <br />(fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Water hector <br />Clothes dryer ' <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust tan <br />_ <br />BackOow preventer <br />Heal pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boller <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />_Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE 19 3105 <br />I hereby cerltily 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 [his typo of work will be complied with whether specified herein or not. The granting of a permit dons not presume <br />to glue authority to violate or cancel the provision of any other slate 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 />Ql1s)Ob <br />Signature o OwnerlContractor/Authodzed gent ale <br />