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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 a .-a 7-0d <br />SITE ADDRESS PARCEL TAX I.D. N PERMIT # <br />Ira - 60-rj4 Sb'4k SW A123W-000-700-07 C57" 031) <br />LEGAL LOTNO. BLOCK TRACT <br />DES'; <br />VdRCR wuuncaa vn v4r nvn� <br />COMMONI"'r"Nom1 7/00 KA�-vtiI teoAb /Ev�rr WA 98103�Zo,-436-6Ig') <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />iA1 r A-16P403 cal 904 -5z 3 37v ,(- <br />CONTRACTOR I)AJ WI�rCG✓+ ..5S Si�l,s ADDRESS CITYIZIP PHONE <br />l7 r 4 p 2 144orr kvC Ova a- T wit q �5- Z `B- 0554 <br />CONTR. LICENSE/ VA-/ Wli w<� 15%m 98ZT'.) <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Electric _ Gas _ Other I 170--1r 000. 00 <br />WORK DESCRIPTION lNftALL(y1 MIY4WAV6 D15#9J (2'PIA.) ON 6 fr/ el -011 1 <br />IN,JAL. LtEcHZONIc EgUIPMrVr IN - Nr-W cAotagr" <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbar/mopletc ) <br />Backnow Deventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <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 />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cenhfy 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 2882tK) WAC <br />)1ru&At & ``�'" L 0-0-07 <br />gna urea wner ontr r ut onze ert Date <br />I1L <br />