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P RMIT APPLICATI <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 Cit)-^100 PARCEL TAX I.D.# P- MIT# <br /> 3003 ti 4S/Ai o /4/� .067Cl `a ) <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> TENANT NAME CONTACT <br /> FOR PER IT PHONE y2, ,_ <br /> GO S-1 /rl r1 L t^4f6-)460/1---5k/ E-MAIL <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> /,tl ►'LWL�" CAA/5r, �2&9 / /CP,S�I�12 tAreoc-&—y <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 9u rJ &1. _Electric _Gas Other <br /> WORK DESCRIPTION <br /> y 1,5y- 6LDG <br /> • <br /> PLUMBING MECHANICAL <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 by the owner of this property to perform the work for which application is made and I comply with the <br /> State Iontractors Law 18.2 'C and 296,'00 WAC. <br /> '972-d05/ <br /> S illrature of Owner/ ontractor/Authorized Agent Date <br />