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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.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS 1.(DmR <br />PARCEL TAX I.D. # <br />PERMIT # <br />3ce3 W C f)­51,10 /L�j <br />I iv 3 <br />LEGA LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYrZIP PHONE <br />,,I <br />eo 1 N Ln <br />TENANT NAME <br />CONTACT FOR PERMIT PH0 E <br />I q2J, <br />gat✓IN6 <br />li��✓y!r D <br />EMAIL <br />COATRACTOR ADDRESS _—CIT-72115 PHONE <br />OEI ry G <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />' Y 11_ � <br />I — Electric Gas —Other <br />I <br />WORK DESCRIPTION <br />/i✓ST 2 JON-bigT X+C- - <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 />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />— <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gasrange <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water healer <br />_ <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backfiow prevenler <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify 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 by the owner of this property to perform the work for which application is made and I comply with the <br />Stale ntraclors Law 18.2/d 296.200 WAC. <br />c �C ZS C <br />/ / 7 <br />Signature of Owner/Contractor/Authorized Agent Dale <br />1�y <br />