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IrERMIT APPLICATIvN <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 <br />PARCEL TAX I.U. # PERMIT # <br />=I-4 I'l-o Ar-/ <br />I (-;RlI' b�2 <br />LEGAL LOT NO. <br />BLOCK TRACT OR SUBDIVISION # <br />DESC. <br />I <br />OWNER ADDRESS CITY/ZIP PHONE <br />TENANT NAME CONTACT FOR PERMIT PHONFf2,�,,I) 3541- 3A�(o <br />S��iiJ �w� LJH(L, E-MAIL cc j d L 6 u2c4_y' LU. <br />CONTRAZSTOR ADDRESS -CITY/I PHONE <br />Ar <br />�,5."��. �vlwls - 53 yvk c <br />CONTR. LICENSE # <br />-I <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />,1.1 K r r i1 <br />_ Electric _ Gas __ Other <br />I $ 2v ,, cz <br />WORK DESCRIPTIO14 <br />Il�hUn [14r.�cr.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 />_ <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />_ <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow prevenler <br />_ <br />Heat pump <br />_ <br />Urinal <br />_ <br />Unit heater <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodslove <br />_ <br />Roof drains <br />_ <br />Other <br />_ <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 0105 <br />1 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 />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 stale or local law regulating construction or the performance of <br />conslructi . al I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Co tract ni La 18.27 RCW and 296.200 WAC. <br />S( al r of er/Contractor/Authorized Agent Dale / <br />l� <br />