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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 1 <br />FROM 8 AM TO 4 PM <br />SITE ADDRESS �.'�DD 7 `� +/��dves <br />7r=' ,S';e,ed'r;y- IOVI- 79E <br />PARCEL TAX I.D. # <br />PERMIT # <br />��d 18co�,3D3 fD <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC.� <br />OWNER ADDRESS CITY/ZIP PHONE <br />a2osE f�oI1 Ems _ �itic� /7a� l i4i2i'NG D&d.r &Ae s✓i!/o _ MP <br />TENANT NAME <br />I CONTACT FOR PERMI PHONE <br />CONTRACTOR CD,SE %{O/b?'A& ,%t,(C- ADDRESS CITY/ZIP PHONE <br />' <taoG itZ°�t�t�it/t g*zai 3�d-4sz- 7s91 <br />CONTR. LICENSE # nosed, ®2 • v J2 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />t-51 <br />_ Electric Gas _ Other <br />WORK DESCRIPTION <br />G�or✓�S'7"�GGG�'?�� aF .S+%uj��� �14M�'G►j ��i�_�G=.�i/GI�- %� <br />33 <br />C �-- 3 �3 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C - air handling units <br />Bathtub <br />Forced air systems <br />S <br />Lavatory (wash basin) <br />J <br />Gas piping <br />Shower <br />J <br />Water heater <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />—L <br />Clothes washer <br />Water heater <br />�_ <br />" <br />Clothes dryer <br />Range hood <br />-. <br />Sink (service/bar/mop/etc.) <br />4 r <br />Exhaust fan <br />-+ <br />Backflow preventer <br />-- <br />Heat pump <br />•- <br />Urinal <br />Unit heater <br />�- <br />Drinking Fountain <br />-+ <br />Boiler <br />-� <br />Floor drain <br />Refrigeration <br />r <br />Grease trap <br />-» <br />Woodstove <br />nYADNIPaws <br />Other <br />Other <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 />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 />e&XN/-1• kP&W 9- zi- 06 <br />Signature of Owner/Contractor/Authorized Agent Date <br />