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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 - vaww.evercettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM $ - ri—O ?w <br />SITE ADDRESS <br />PARCEL TAX I.D. M P"MIT • <br />S ucker <br />cY 1� 'oC, cz�Qo 1- <br />LEGAL LOT NO. LOCK <br />1 TRACT OR SUBDIVISION 1 <br />DI <br />OWNER <br />_ _ <br />1DDRFSS CITY/ZIP PHONE <br />ahrot i(-ZNM51 ne4 UC, <br />PoIWA NerO- �1121j <br />TENANT NAME <br />CONTACT FOR PERMIT r PHONE <br />1�lbrld �OI�J�Ct' �� AIL ��{p1rCpv&lft <br />'CONTRACTOR <br />OLT <br />FOTUIer IA-1(01( leaf _t cDox 15'lt �akF S#`��,�g R825�f 42S 3 -lam <br />CONTR. LICENSE <br />OF BUILDING <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />'USE <br />kni-c�.Y C�IY1lG I <br />_Electric —Gas —Other ��Cfn1/i.?ri�L, GmQ, <br />WORK DESCRIPTION <br />xn,5 1 Rauch In ># 7"nim <br />-�y - iYhil_s <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF nx URE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />_ <br />— <br />A/C— air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />l� <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />_ <br />_ <br />Water heater <br />_ _ <br />Range hood <br />l _ <br />Sink (service bar/mop'elc.) <br />Exhaust fan <br />Baokllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />GtRass trap <br />Roof drains <br />OlhetHtX, LA ��Lt if*5 <br />n],� i,frll Air <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeratior <br />Woodntove <br />Other <br />_ <br />� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify that I have read and examined this <br />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 />tog�ive authority to violate or cancel the provision of <br />any other state or local law regulating construction or the performance of <br />/tons1l,tiction. that I am aipth0rized by the owner of this property to perform The work for which application is made and I comply with the <br />trry slLaw 7 n 196.200 WAC.--- <br />\State <br />5I ;�010—i <br />