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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.P1)C4 1304-tom" fit' SO PARCEL TAX I.D.p PERMIT p <br /> 1 00 3' i%0-1 70-2 U0� <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC <br /> OWNER ADDRESS CITYIZIP PHONE <br /> 9s�Lat S b,00l D;s1c;�+ y730 cnll,L< hue. Cu�re� 95,A03 (ya16)23s-` 1 <br /> TENANT NAME I CONTACT FOR PERM PHONE <br /> F-Vere* S(-V%wi D;slHc-j t1 s r� �:ey Gh(XnL 6- \\n - 3 �i7 aZ''7 AX;L <br /> CONTRACTOR fdlnCr Cc r%�i rL a:"\ ADDRESS 1� CITYIZIP PHONE <br /> 7855 S�6 si m 71ros� &-A5)81a-7,ZAa <br /> CONTR.LICENSE/Armee, )(a Iq DR _ <br /> USE OF BUILDING Ufa ce-) 51i7r08c/ I — HEAT SOURCEI $ Rjo-aq CONTRACT PRICE OF WORK <br /> Mr�nien�nl_e Electric Gas—Other <br /> WORK DESCRIPTION M3 Q;"7 n� t JPS hlyl�r5 I� E};,g1 n� bu,\a;n� for f\ew <br /> Wc�1\s hez-L"n;ne. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ <br /> Toilet _ AIC-air handling units <br /> _ Bathtub _ Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> _ Shower _ Water heater <br /> _ Kitchen sink 8 disposal _ Gas fireplace <br /> _ Dishwasher _ Gas range <br /> _ Clothes washer _ Clothes dryer <br /> _ Laundry tray _ Range hood <br /> _ Sink(service/bar/mop/etc.) _ Exhaust fan <br /> _ Backflow preventer _ Heal pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain _ Boiler <br /> _ Floor drain — Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains _ Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7103 <br /> 1 hereby cerltify 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 slate 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 296200 WAC, <br /> f y7-y <br /> .!a/fO �2 J-GZ <br /> Signature or Owner/ onlramorl ul onze gent usie <br /> 16 <br /> yz. <br />