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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICO FEB 1 7 201'9 <br /> 3200 CEDAR STREET, EVERETT, WA 98201I CITY OF F� R <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.0 g Permit ServicesT <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> LEGA LOT NO. BLOCK TRACT OR UBDIVISION# <br /> . <br /> DESC �'t O <br /> OWNER ADDRESS �`iQ1. ZIP PHONE <br /> t 0 , n <br /> TENANY NAME CONTACT FOR PERMIT PHONE �` '70`3 <br /> LWIM(r c :� <br /> E-MAIL C Jr1'1 <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �-A(w CLf <br /> Electric _Gas Other <br /> W RK qE� (✓SCRIPTI f l �� 00}�1 I <br /> Purper- -/�Wa cwty bar /000 . L JS <br /> � <br /> tli� 1 ��11t , <br /> PLUMBING MECHANICAL' G �1S <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I 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 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 authorized b the owner of this property to perform the work for which application is made and I comply with the <br /> State Contrac Law 1 .27 R _ n.- 6.200 WAC. <br /> igna ur caner/ ontra' Au Agent Da(e <br />