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PERMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES 412�Io`� <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 <br />I PARCEL TAX I.D. # <br />PERMIT # <br />(t"l0 Ede%JAI15ulir $ <br />1 Cc, 4tc2oo,j01000 <br />p)owct.c--,(-)kQ <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />I)A\J11) O'GCNIJoµ- <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />h13; LI,G db.; EAI,L. (�,a ti\FltL)i <br />IZ1Ll l/\Rq <br />CONTRACTOR{/— ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT F'RICE OF WORK <br />C CII(1_ NLt o s l v� kL jLJt JILQ <br />I <br />_ Electric _ Gas _ Other <br />WORK DESCRIPTION � <br />4L <br />mo <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM 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 />_ <br />Water heater <br />_ <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />Warr heater <br />Range hood <br />_ <br />Sink (service/bar/mopletc.) <br />Exhaust fan <br />_ <br />Backflow prevenler <br />Heal pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby coritify 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 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 />conslruction�)Thal I am aulharized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractor La 19.2; F CW and 296.200 WAC. <br />Signature of Owner/Contractor/A thorized Agent Date <br />