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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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. ell �S Cony-utJ <br />PERMIT # <br />OWNER <br />ADDRESS <br />is <br />CITY/ZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT <br />PHONE <br />kk <br />CONTRACTOR <br />Ra-aLlk. <br />ADDRESS -aC�- <br />CITY/ZIP PHONE ' <br />CONTR. LICENSE # <br />R QZ L t� �• C -.i <br />USE OF BUILDING v s- <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric _ Gas _ Other <br />WORK DESCRIPTION <br />n <br />Ast1�n ✓ 9- U-�4"��. <br />�.i !-.C�-a ,. , <br />t <br />r 2) 7 <br />PLUMBING <br />MECHANICAL <br />NO.. TYPE OF FIXTURE OR ITEM• <br />FNO- <br />I <br />TYPE OF FIXTURE OR ITEM <br />3 <br />Toilet 1) r <br />Bathtub I 1 f <br />Lavatory (wash basin) I I I <br />Shower <br />Kitchen sink & disposal i; ` ='' ; <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />.Roof drains <br />Other <br />t <br />I <br />_� <br />I <br />i_ <br />t <br />57 <br />A/C —air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood i M t 0.Co <br />Exhaust fan v e-4' <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />_q_ <br />I_ <br />l <br />`1 <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 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 Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />