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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 ADD S t� <br />PARCEL TAX I.D. # <br />P IT #//' <br />1-onLisocc2oninnt <br />no <br />LEGA LO O. BLOCK <br />TRACT <br />DESC. I <br />OWNER ADDRESS U CITY/ZIP PHONE <br />L.e-�nmes 1-u.S,Lki.S+evehs L12•S}, yens �JZs <br />{��J Inc. <br />9NA. 2r0 9gzE1V 33q.05 73 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />11rin <br />�'-�; �berk5m 3 -Os 73 <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />LACjACun4LRh <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />5� R <br />_ Electric Gas _Other <br />/ XvG� <br />WORK DESCRIPTION <br />sF R j 223 <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 />I <br />Forced air systems <br />Lavatory (wash basin) F - <br />; <br />Gas piping <br />Shower + <br />I <br />Water heater <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />Dishwasher <br />_(_ <br />Gas range <br />Clothes washer <br />�_ <br />Clothes dryer <br />— <br />Laundry tray <br />_L <br />Range hood <br />�- <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />Backflow preventer <br />— <br />Heat pump <br />— <br />Urinal <br />— <br />Unit heater <br />-- <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />-_ <br />Woodstove <br />-- <br />Roof drains <br />-- <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 Contract Law .27 RCW and 296.200 WAC. <br />O <br />Signature of wner/ ontractor/Authorized Agent ate <br />