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PtRMIIT 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 qo - I . 2-- <br />PARCEL TAX I.D. # <br />7RMIT # <br />soo <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />_ <br />OWNER ADDRESS CITYIZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />>0 C5,1 Al C, <br />,/ <br />(i. „��,QOr�r l cl2�. ffG —`,137 <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />F/a-G re.-r—, — Electric _ Gas _ Other 00 <br />WORK DESCRIPTION <br />��vJs rn tti %• J L r:7-1 r� NS i�yi'Lc-F_'J- �'L/}'G l� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C - air handling units <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 />_ <br />Dishwasher <br />Gasrange <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow provenler <br />_ <br />Heat pump <br />_ <br />Urinal <br />_ <br />Unit heater <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodstove <br />_ <br />_ <br />Roof drains <br />_ <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 coned. All provisions of laws and <br />ordinaces governing this typo of work will be complied with whether specified herein or not. The granting of a permit do— 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 by the owner of this property to perform the wuk for which application is made and I comply with the <br />State C nL�aw 18�7 RCW anij 298.200 WAC. <br />l <br />-r 7 <br />Signature of Owner/Contractor/Authorized Agent Date lIL <br />