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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 />TE ADDRESS <br />_ r 0� l�-' <br />PARCEL TAX I.D. p PERMIT 0 <br />4300M I G 71�7-21� <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. 10 <br />OWNER ADDRESS 7Qa n I �(TwYl�Z�IP',,1 PHONE L�' S- <br />bN d -TEA R-&L R►f.� y �yLCLWit 01 %,?( `{ <br />TENANT NAME <br />_ <br />CONTt �CT FO� �Pt IT r PHONE <br />�L�'12Cii <br />)rlN l M A)3--7/ii <br />CONTRACTOR PHONE <br />&1rA <br />` JQZESSS ICITY/ZIP <br />NE <br />rC�'C <br />W�ELi I�N�, <br />USE OF BUPDING HEAT SOURCE CO ACT PRICE OF WORK <br />IJ Electric. _ Gas _ Other � . <br />All <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />__ <br />A/C - air handling units <br />Bathtub <br />Lavatory (wash basin) <br />Forced air systems <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washor <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />Rango hood <br />_ <br />Sink (sorvicolbar/mop/etc.) <br />�_ <br />Exhaust fan <br />Backflow preventor <br />licat pump <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />__ <br />Boller <br />_ <br />Floordrain <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Other__ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />1 hereby ceritify that I have read and examined this application and know the same to be true and correct. All previsions of laws and <br />ordinates I ing This type of work will be complied with whothar specified herein or not. The granting of a permit does not presume <br />to give y to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />QQQbbbnstruction. hat I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />$lalo Contrac s Law 18,27 RCW and 290.200 WAC. <br />\\ ♦ Lf <br />signature of Owner/Contra or/Aulhorized Agent Date i <br />