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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SLRVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-6357 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. N <br />PERMIT M <br />12�1 �= Avg. <br />9 <br />LEGA LOT NO. <br />BLOCK <br />TRACTOR SUBOIVISIONI <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE AtS - LZo -gq <br />Roto��TE�tiI1TA A1001- --V724 661.yL-�_ M/G I Eir gfi2a3 <br />TENANT NAME <br />CONTACT FOR PERM[ I;-:: ���a--nnlD II PHONE tag -SI,L -$X06 <br />T71ai EMAIL k0.,, C 1 l0j0%�SQ0WA- <br />— <br />-PONE <br />ObNf�lfLT6R- <br />1;Koz' ALoev PAers I.I.G. I0-ter` AV SE eVimootr LIJzcr 42i. 12. 8t ol, <br />CONTR. LICENSE r T_L0 G- LLB q34 I � <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I <br />— Electric —Gas —Other <br />eo <br />WORK DESCRIPTION S4 / <br />124E L t.k=_ ey4sT1o& Gvow- -�Ks, DNe T:�eDmli c*qe sae is Cow <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />AIC-air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />_ <br />Water heater <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />_ <br />Range hood <br />_ <br />Sink (service/bar/mop/oic.) <br />_ <br />Exhaust fen <br />_ <br />Backllow preventer <br />_ <br />Heat pump <br />Urinal <br />_ <br />Unit healer <br />Drinking Fountain <br />_ <br />Boiler <br />Floordraln <br />Refrigeration <br />_ <br />Grease trap <br />_- <br />Woodstove <br />_ <br />Root drains <br />__ <br />Other <br />Other <br />--- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined [his application and know the same to be true and correct. All provisions of laws and <br />ordinates 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 />Slate Con traclas, w 18.27 RCW and 296.200 WAC. <br />nn <br />`'I .Q'6 <br />Signal Iof Owner/l raclor/ ut or[zed pent Date <br />