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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.D. # <br />PERMIT # <br />_Q54 1u9N hue 5E <br />rS 73 <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />`� <br />_NAoCK )EIACEIRDA /7VAAkIr J`(z r✓r_f,E;%; 992a5_ Zob_z1"Y-39zS <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />71215 5PoN_56AP <br />&URe k G2,uprr_ t(" - ZY4-7S 37� <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />GAS)tlJ//3itlL�il�jsl���L137A�(� <br />_Electric_Gas_Other <br />I�IAUC-fKeW <br />WORKDESCRIPTION 1"ONPOn (AP 'RDA. VfeWIAJ6 "0^-- ON": <br />Amoa PI T' / L.EUEL FLOOR FQr2 JA4tfS (N V/EWIAK( ✓UOM <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Water heater <br />_Shower <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink(service/bar/mop/efc.) <br />Exhaust fan <br />Backflow prevenler <br />_ <br />Heal pump <br />_ <br />Urinal <br />Unit healer <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />__ <br />Refrigeration <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 />1 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 />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 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 Owner/Contractor/Authorized Agent Dale <br />/" <br />