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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 />PARCEL TAX I.O. # <br />PERMIT # <br />KAcker <br />Cjb 3RIgtpgCC71OI <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION p <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />► JARK (ZEICHI In IcFo(c MARINI= bK, N, MAi?.YSylu;�, q�qt (24L-0S10-25 <br />TENANTNAME CC TE{ZOfAv')i <br />CONTACT FOR PERMIT PHONE(2cb)22-j�--34.6$ <br />KLAO(i Wcc' CHDC—i <br />LJTH(1Z. FoGF-0 kGGCE-MAILWCL"toIVS-fQQCl- <br />CONTRACTOR ADDRESS Tl—Y/zii' P ONE <br />11AAN--RC-G NSf2L(Cfi111�1 INC., 146C� `fit`' PI- N1. SHQZC-L E- <br />CONTR. LICENSE # t1 O 06 N 9 9 2 i 55 <br />MAN (L�G'i O <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />�j-Al(tZ1\(uT <br />_Electric 4Gas _Other <br />4S1000, 00 <br />WORK DESCRIPTIONWORK-Got--:tuct A K'T�NE� <br />'i we Tci LET Aoer-tst first" foUl�-{Z, fI <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C - air handling units <br />Bathtub <br />Lavatory (wash basin) <br />Forced air systems <br />Gas piping <br />Shower <br />Water healer <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />— <br />Exhaust fan <br />oV- <br />Backf ow preventer <br />— <br />Heat pump <br />Urinal <br />_ <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />�. <br />Roof drains <br />`. <br />Other phA 1'i]LC,T .I 2 mc'-6n1-.'e— <br />Z <br />Other <br />eljr Ir <br />.DiQAftJ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify that 1 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 slate or local law regulating construction or the performance of <br />construction. That I ant authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Slate C tract rs Law 18.2 W and 296.200 WAG. <br />I ► 7�zoog <br />Signature of Owner/Contractor/Authorized Agent 1 Date I/ <br />L <br />