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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 /JPARCEL TAX I.D. # PERNAT # <br />LEGA . LOT NO. <br />DESC. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />OWNER b <br />�n� <br />! x 11+ <br />� <br />ADD ESS r q 5v j WcrrY I <br />•�►-� , <br />PFIONE G <br />v� <br />ten• <br />TENANT NAME <br />I <br />CONTACT FOR PERMIT <br />PHONE L44 S. (IFS I <br />l f'1SC,I`i <br />E-MAILCOW <br />MACTIO <br />fQ-614E, <br />A-rj CMC--�Lo J", <br />MORE <br />CONTR. LICENSE # <br />alo <br />t 3o4- 1'Ylc1Z r U .`�� WA C(%3--10 <br />USE 60BUILDINIG <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric. Gas — Other <br />WORK DESCRIPTION <br />Lo _ <br />PLUMBING MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <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 />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 <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that l 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 compiled 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 />