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PERMIT APPLICATION <br />---7CITY <br />OF EVERETT PERMIT SERVICES <br />,. <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.D. # <br />PERMIT # <br />LEGA LOT NO. BLOCK TRACT /�" <br />DESC. <br />(414/ / f <br />OWNER ADDRESS C /ZIP PHONE <br />fie41-er-',cX- el�-.✓-lvi z s,V 9 tiF L!c e.�s zs` <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />PH N <br />G� � -7.i <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />)5 k <br />edev'f Ch ae/t s <br />CONTR. LICENSE # <br />• ��/ UGC sSdq ' <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric _Gas _Other <br />100,0670 <br />WORK DESCRIPTION <br />3027 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />3 <br />Toilet <br />A/C — air handling units, <br />.2. <br />-3 <br />Bathtub <br />Lavatory (wash basin)' <br />Forced air systems. <br />Gas piping `r <br />Shower <br />Water heater <br />Kitchen sink &disposal <br />Gas fireplace' ' <br />Dishwasher <br />_ <br />Gas range <br />Clothes washer <br />_� <br />Clothes dryer <br />Water heater <br />_� <br />Range hood <br />Sink (service/bar/mop/etc.) <br />� <br />Exhaust fan <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Roof drains / <br />Woodstove <br />Other <br />Other t/ <br />- <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 riot. 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 Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />