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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 />S>{ SGv <br />PARCEL TAX I.D. p <br />PERMIT If <br />I <br />04 ���� <br />Wc-ira3o000070U <br />3� <br />LEGA LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION 0 <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />W,I1 d Je4..�� /11w,stio// zo,r,2i 3�t4AW bm� (,/N 9i,24.2 <br />TENANT NAME CONTACT FOR PERMIT PHONE C�,�-S',3,. .2 YS- <br />' <br />f/'ITUr, u/rrr1err �es ('oo /C E-MAIL ,- .54 eCOO <br />KAUIUM(�Qc, C�rlf/,•. /y/� j„rA 5YL Sh/Q •*ff Y1f-,2f.2-1.28.2 <br />/tzfi <br />`PJ13 <br />CONTR. LICENSExwnL.,I '�`elBol313� <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />77N/� <br />N�/T <br />Electric _Gas_Other <br />/v o� <br />WORK DESCRIPTION 12e, TC . tI, <br />1 SGM t eletx, Ilr ,j uJ '�16 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C - air handling units <br />_ <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />__ <br />Clothes dryer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Back9ow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />drains <br />_ <br />_ <br />_ <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boller <br />Refrigeration <br />Wlwdstove <br />Other <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />=Roof <br />Othe <br />Other — <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerltify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates 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 or <br />construction. at I am authoLWed by the owner of this property to perform the work for which application is made and I comply with the <br />State Co c rs La 18. d 296.200 WAC. <br />S-/?-oq <br />Ignalure of Owner/Contractor/AupOrizedgent Dale <br />