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PERMIT APPLICATION 7-16 --OY <br />CITY OF EVERETT PERMIT SERVICES 1,70-gp7-a77- <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. M PERMIT N <br />HNI� A'rr(' I IIa 7 »nv NJ <br />LEGAL LOTNO. BLOCK/) TRACT <br />DESC. <br />SChmldC Zac"51-We.12 ��lvu l2/� /ar'aSf - iJlaura�lllet' �r�,27/ <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />!liar k 6/0 11 1;2c7 <br />CONTRACTOR ADDRESSt.I, %X lit CITY21P PHONE <br />A�l9hl Cal 11<'uE;)AteLievHa5.335�1�07 <br />CONTR. LICENSE ".0161!lTITIMOM1 / ' <br />USE OF BUILDING I HEAT SOURCE con I KAc I eran.m ur ovnn <br />e8lec //ldlt'a � _),Electric Z Gas _OMer <br />WORK DESCRIPTION ' <br />01'1;1117el-na/ #V/'PC Stgslvl"s 11"d gas <br />PLUMBING <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />NO, <br />AIC — air handling units <br />Toilet <br />Bathtub <br />basin) <br />.� <br />_ <br />_ <br />Forced air systems <br />Gas piping <br />_ <br />_ <br />Lavatory (wash <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />_ <br />_ <br />_ <br />_ <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />tray <br />Sink (servicelbar/mopletc.) <br />Exhaust fan <br />Heat pump <br />=Laundry <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodst ve <br />L. <br />Grease trap <br />Roof drains <br />Other - S tee <br />t I <br />.15 <br />Other <br />All" 111lic <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby centify 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 />Signature of OwnerlContractorlAuihorizetl Agent Date <br />