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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICESq <br />3200 CEDAR STREET, EVERETT, WA 98201 qC/O <br />425-257.8810 — FAX 425.257.8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />SITEADDRES I PARCEL7A1.D.If PERWrt <br />To r10 I /_,0 733 -� <br />LEGAIJ LOT NO. BLOCK TRACT OR SUBDIVISION / - <br />OESC. <br />O ADDRESS G TP PHONE <br />�/1�'a NFU F�fi icY on's� %w �u�l'rTQBav3 <br />TENANT NAME �— CONTACT FOR PERMr PHONE ¢ <br />5M6 I *Z E�Nid Gm <br />1�� ��``�� ��//�,{������r EMAIL <br />L[Z('l %r/l/1Ti/f %✓r/�Ocf.S/ /NG. �S ...tttrrr �C[ 4aA4K-` &, ,4 <br />CONTR. LICENSE • o �K•U6 ' %S 7- / / �" <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />/U(�i c SKY �� 5 Q — Eledrk �Oas _ Other 'o <br />WORK DESCRI ION T.•ie..� ,cdJP ,AXra n 3yJ a- 6 uF "I in x u� <br />166-/erl /--SVrj+j <br />M�r of'lyd irew%SfNcfo�n �✓r nnc <br />wT-t&/W �C <br />Gdt;Ymor ii7w,s,randrfA,/p/a//o�o t/�i9rcPP�si/fdfsf r ar remPruL5aT/7�a� ,�/fP+GxZ7 tuiriluiiv+t'7U7aCnccr{ aoa�r/dc <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM pi�77F1_ NO. TYPE OF FIXTURE OR ITEM <br />Toilet _ A/C - air handling units <br />Bathtub Forced air systems <br />Lavatory (wash basin) — Gas piping <br />Shower _ Water heater <br />Kitchen sink 8 disposal — Gas fireplace <br />Dishwasher _ Gas range <br />Clothes washer _ Clothes dryer <br />Water heater _ Range hood <br />Sink (servins/bar/mopretc.) — Exhaust fan <br />Backilow preventer — Heat pump <br />Urinal _ Unit heater <br />Drinking Fountain _ Boiler <br />Floor drain Refrigeration <br />Grease trap — Woodstove <br />Root drains Other____ <br />Other _.--------- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 5105 <br />1 hereby ceritily 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 ontractors LAw 18.27 RCW and 296.200 WAC. <br />SignIture of Owner/Contractor/Auth" Agent ' Date t/L <br />