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PtRMIT 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 ACCENTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />31005 P>evud b1v - EoenxtFl 18Zo� <br />PARCEL TAX I.D. # <br />06303 9001 � aoo <br />P RMIT # <br />'70(o -_3 <br />LEGALT LOT N0. <br />DESC. <br />BLOCK <br />TRACTOR SUBDIVISION # <br />OWNER ADDRESS CITY/ZIP PHONE <br />HoG T✓nrt lob- Col" PL SE - "Qu11, q?;,03 47-5 ,2f'O8 -&(cq q <br />TENA T E <br />° N I <br />CONTACT FOR PERMIT PHONE <br />�n <br />CONTRACT6q ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE # tJ / A <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I — Electric Gas Other <br />I <br />WORK DESCRIPTION <br />f ,Ai ue nevo <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilot <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systerns <br />_ <br />Lavatory (wash basin) <br />_ <br />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Water healer <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow preventer <br />Heat 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 />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 nr,, presume <br />to give authority to violate or cancel the provision of any other slate or local law regulating construction or the performance 0 <br />construction. That I am auth jrized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors LaW'I .27 RCW and 296.200 WAC. <br />L / <br />Signature pb er/Contractor/� Agent Date <br />Ir� <br />