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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 <br />PARCEL TAX I.D. # <br />PERMIT # <br />1010(00(:1-00C)- <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />1 <br />/ • <br />OWNER <br />ADDRESS' CITY/ZIP PHONE <br />9gZ58 y 26332-Q5 73 <br />1- <br />TEdAT N <br />CONTACT FOR PERMIT PHONE <br />I <br />CONTRACTOR <br />ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />LF- - Ac <br />AC)tAyIiY, <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />SO <br />_ Electric Gas _ Other <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />' <br />Bathtub <br />I <br />Forced air systems <br />,,c;_ <br />Lavatory (wash basin) <br />IT <br />Gas piping <br />/ <br />Shower <br />I <br />Water heater <br />I <br />Kitchen sink & disposal <br />I <br />Gas fireplace <br />l <br />Dishwasher <br />_� <br />Gas range <br />J <br />Clothes washer <br />1 <br />Clothes dryer <br />Laundry tray <br />I <br />Range hood <br />1_ <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 />Woodstove <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 />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 Contracto Law . <br />CW and 296.200 WAC. <br />,-A �) DVAA ) � j , <br />�D 1 0 1) ( d JA-i `7-11 /,0 1�(_ <br />Signature of OW—nbr/C MrastoftAuthonzed <br />Agent Date <br />