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P�RMIT 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 I PARCEL TAX I.D. # <br />tF, l <br />PERMIT <br />d <br />-::)zL)l c ta-I, 0� Sir f � I o0439171,SZco l2/ <br />R ,D <br />LEGALF LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE 20� <br />PIdgK nJ %�nl A%A/I/l�_fY /V SI/,// n2/ 57o-2-s4:!�; <br />TENANT NAME CONTACT FOR PERMIT PHONE (,Zoo -33,0 <br />E-MAIL/)�LIn/t'l!X 0N4-14cL <br />A <br />I'N'11.1-koc 6c7lVS%RtfCTIG7�, /nz (�Fdo� 9r� N E, sN�2�7nL�, »6� <br />CONTR. LICENSE # 550 - 33SC, <br />/19f4N?CCcz 95(5?N)R <br />USE OF BUILDING <br />HEAT SOURCE <br />I CONTRACT PRICE OF WORK <br />I' 7 <br />_ Electric X Gas _ Other <br />Zo (foQ r n O <br />i <br />7 <br />WORK DESCRIPTION <br />60N572cJc7' 1GJo S/A)61,t= L,Cc a/',j& i T1LF-F- ��'�. r•�S <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Water healer <br />Range hood <br />_ <br />_ <br />Sink (servicelbar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify 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 />Stale Co Iraclors aw j8.27 CW and 29G.200 WAC. <br />Sigealure of Owner/ConlraclorlAulhorized Agent Date <br />uj'y' <br />E!"' <br />