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PERMIT 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 `is- '7 ys PARCEL TAX I.D.# MRMI-1 <br /> 3o03 L 1 C1 -$, o /Z.P 1 O '007' <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> BCC/G‘J6 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 7 ez-x-94./ <br /> 1 ()L I r.I q , 3?"b /.-3- go t-.SIC/ E-MAIL <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> GJl1-L i-,nn 5Go1Sp' m'i <br /> CONTR.LICENSE# <br /> tAi (s 0`2.1 P <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> o <br /> Electric Gas_Other S r V 0 <br /> WORK DESCRIPTION <br /> /A/.5ra-44 LCtt <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 ontractors Law 18.27 R W and 96.200 WAC. <br /> rZ P <br /> 'Nature of Owner/Contractor/Authorized Agent Date <br />