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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 PARCEL TAX I.D.# P MIT# <br /> 213'ig wcf,,2� 00690 '� <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC.` <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> (Rem ,k.� <br /> TENANT NAME the ,///4 5. CONTACT FOR PERMIT PHONE <br /> EM c.),,---.0^-c./2- 4/2r ZS" -t©o' <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING (1Jen k- GK. L4 HEAT SOURCE CONTRACT PRICE OF WORK <br /> CCoLi 5 Electric _Gas—Other i00 JO t <br /> kr"t A-5 h0Rio(Lc. L�ResVot <br /> WORK DESCRIPTION N 10 ij t Iioe etilx_ \ i 1 2 ,k,� -k,T t \ <br /> �d,/,1 _. 1J A Q-- w 41-- I D . `-rLl 5 ; s skA kl. iN, :A-u ai Ntz ek..o,Jv st- 13-e c�•L <br /> I d P y, Pa C0 E_t_ SI^a ip .5- wo,Ak V,, tCc. ft, opc#3 You . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 6 Toilet NC-air handling units <br /> ® Bathtub Forced air systems <br /> 6 Lavatory(wash basin) Gas piping <br /> Shower I Water heater <br /> _L,.. Kitchen sink&disposal Gas fireplace <br /> 1 /- Dishwasher Gas range <br /> 6 Clothes washer Clothes dryer <br /> IWater heater I Range hood c1AS5 A <br /> Sink(service/bar/mop/etc.) I Exhaust fan <br /> / Backflow preventer Heat pump <br /> I Urinal I Unit heater <br /> O Drinking Fountain I Boiler <br /> / Floor drain i Refrigeration <br /> 6 Grease trap i.(44-,i i ill, Woodstove <br /> i Roof drains OtherNo Goras4roc-0 a 43 d1c rc>� <br /> Other v^est NCS <br /> A tl "/,J Hid-(-i %q, oCcAi S o2 60 �2 c1� roto <br /> K11 110 e 1Act b�To"Li .-. ecLU p te( <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 /> �`i cl,A...---- Af/i 25 206 <br /> Owner/Contractor/Authorized Agent Date <br />