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I <br />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 7 � <br />SITE ADDRESS <br />PARCEL TAX I.D. A <br />PERMIT i <br />LEaAQ LOTNO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYTP PHONE qJr 97 f <br />C&LjAk,%x r-iq r-s-w lRo Fl/e.e-o 14VE EVP-ej� 9e2p� <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />ee)IUw. R� k- V41''ACLIP 4251 R2 Z 1200 <br />CONTRACTOR ADDRESS PITYMP HONE q2.5^ <br />T�}E S,cjH ,�'Clvr'/ $/S � 4clr/Clo49-fSa" <br />CONTR. LICENSE 0 / <br />�lGvlbA V n2U I Q <br />USE O�DING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />6i <br />_ Electric _ Gas _ Other <br />Sb 0 . cJ O <br />WORKDESCRIPTION VkcUVQ <br />lt"LL t f sauce. 4xQ,lt-t o v�'I 3. <br />i2ec��c,L c?1Rn� �iquy �t e. <br />tzp- sC�" I a owl SlIL-R - <br />PLU BI MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />_ <br />A/C — airhandlingunits <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (servicelbar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backfiow preventer <br />_ <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALFS TAX CODE IS 3105 <br />1 hereby ceritify 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 />co ction. 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 />at Contractors Law .27 RCW and 296.200 WAC. <br />'LLt� <br />ature of ov)ner/ContracrortAuthonzecl Agent t Date I v <br />I <br />