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PARMIT APPLICATIJ <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 (1'5- " PARCEL TAX I.D.# P RMIT# <br /> it <br /> Sao- Cv, e74-5/Aid D�ur F1©o -617 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> 1001 tk, <br /> TENANT NAME CONTACT FOR PERMIT /PHONE _ t� <br /> 60E7 /46 l <br /> tr��orfAl� �� 9�s�E-MAIL �� , �� "~���5 �/ <br /> CO TRACTOR ADDRESS CITY/ZIP PHONE <br /> 1 0E016, <br /> • <br /> CO TR. LICENSE# <br /> USE OF BUILDING • HEAT SOURCE CONTRACT PRICE OF WORK <br /> • _Electric _Gas_Other 000 <br /> WORK DESCRIPTION <br /> /,V ,114- L 0`"-R ice/ t. . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEMNO. TYPE OF FIXTURE OR ITEM <br /> • <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 /> L,".- 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 drainsOther <br /> Other C7/� IrOG41.-- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinances 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 ntractors Law 18. 'C and 2901200 WAC. <br /> , 3/2:,'3 //0 <br /> Signature of Owner/Contractor/Authorized Agent Date <br />