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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 S AM TO 4 PM . - / — 0 <br />SITE ADDRESS PARCEL TAX I.D. M IT / <br />C)fnn4 AUrt Sullk -3oo C Drt�3q ( 6 11�zyo D 6S/ <br />�2CLl- <br />LEGA LOT NO. BLOCK TRACT <br />DESC. n�RV 2 61.71- -C li <br />ADDRESS CITY/ZIP PHONE <br />OWNER <br />.1c�d�,� ���'1 �� �2o4 9fni4 AVM, Cvereff ,wA q7-Sw4z*ro <br />NTE�NANT NAME CONTACT FOR PERMIT PHONE <br />Sou �f-fcl-�Sfi�C ��al� I �v�SGny �a�yey ��S ��rZ �-So 0 <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE N <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACTPRICE OF WORK <br />0 �� ; ��, <br />M <br />I Electric _ Gas _ Other <br />n <br />[I 6 OD t4t/ <br />WORK DESCRIPTION <br />('c j5'fK&- t� r Vw <br />�L PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />_ <br />_ <br />Bathtub <br />— <br />Forced air systems <br />Gas piping <br />_ <br />Lavatory (wash basin) <br />— <br />Water heater <br />_ <br />_ <br />Shower <br />Kitchen sink & disposal <br />— <br />_ <br />Gas fireplace <br />Gas range <br />_ <br />_ <br />Dishwasher <br />Clothes washer <br />_ <br />— <br />Clothes dryer <br />Range hood <br />_ <br />Water heater <br />Sink (service/bar/mop/etc.) <br />— <br />— <br />Exhaust fan <br />_ <br />_ <br />Backflow prevenler <br />— <br />Heat pump <br />Unit heater <br />_ <br />_ <br />Urinal <br />Drinking Fountain <br />— <br />— <br />Boller <br />Refrigeration <br />_ <br />Floor drain <br />— <br />Woodstove <br />_ <br />Grease trap <br />_ <br />Other <br />Roof drains <br />— <br />_ <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES 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 />be complied with whether specified herein or not. The granting of a permit does not presume <br />ordinates governing this type of work will <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />to tho work for which application Is made and I comply with the <br />construction. That I am authorized by the owner of this property perform <br />State Contra tors Law 18.27 RCW and 296.200 WAC. <br />CI // R- <br />I <br />Signature o Owne / ontractoriAuthorized Agent Oale <br />