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FCRMIT APPLICATIVN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257.8857 - www.everettwa.org 6 _11 ..0 7 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM X 70& <br />SITE ADDRESS nn PARCEL TAX I.D. # Fj§RMIT # <br />IYY <br />'77 4378—Cc q 2oZ/ <br />-ro1 oa <br />26o <br />`7 <br />TRACLEGAL LOT NO BLT <br />DESC. IEVIFAcm <br />Z <br />ADDRESS CITy21P 'PHONE <br />OWNER <br />'� ICI CIS L ?6r) j / /76C L11WE77 <br />= L /� ,�'c% <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />- 1111C010 �qZS 232 3qz� <br />CONTRACTOR/ ADDRESS CITYIZIP PHONE <br />A I <br /># l <br />CONTR. LICENSE <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />�` L= D L NCt <br />_ Electric L Gas __ Other <br />�— <br />WORK DESCRIPTION 7 <br />Fro �IELJ tJf��N12ccNq EXe-e7r-ock <br />---- PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />__ <br />A/C — air handling units <br />—1— <br />Bathtub <br />Forced air systems <br />piping <br />Lavatory (wash basin) <br />—Gas <br />a <br />Water heater <br />_ <br />Shower <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />Gas range <br />Dishwasher <br />_ <br />Clothes dryer <br />Clothes washer <br />_ <br />Range hood <br />Water heater <br />Sink o e/bar/mop/etc.) <br />T <br />Exhaust fan <br />w prevenler <br />fl pr <br />Heal pump <br />Unit heater <br />_ <br />Urinal <br />Urinal <br />Drinking Fountain <br />Boiler <br />Refrigeration <br />Floor <br />Woodslove <br />trap <br />Grease trap <br />Grease <br />Other <br />Roof drains <br />— <br />_ <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 />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 cannel the provision of any other state or local law regulating construction or the performance of <br />for which application is made and I comply w;th the <br />construction. That I am authorized by the owner of this properly to perform the work <br />Slate Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of ner/C ratter/Authorized Agent Date <br />