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( <br /> 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 ARt ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.U PERMIT N <br /> a6 a.o t��l w�. - >.�//-�';, <br /> LEGA LOT N0. LOCK TRACT <br /> DESC. <br /> OVYNER ADDRESS CITYIZIP PHONE <br /> II��� E4-�o� ��I uw� � �akeS�eucks 33�{-(333 <br /> TENANT NAME I CONTACT FOR PERMI7 PHONE <br /> c �e�ro..� ���ll (�.,c � 360- q2�(-�3zs— <br /> CONTRACTOR ADDRESS CITYlZIP PHONE <br /> (n'1t.(.a-s'rjc�ti �--(lc�u_J��S�x.`� 2600 F�wY 49 s�''� ��_ �2�-l32S <br /> CONTR.LICENSE fl / �i \ �� ��� � <br /> (�IeY.eJ'SA o38 Q� f 1� ^ 7 ) <br /> USE OF BUILDING I HEAT OURCE CONTRACT PRICE OF WORK <br /> e�e <br /> �5 '-�h _[Iectric _Gas_Other �� � � <br /> WORK ESCRIPTIO <br /> (�S�c� C�2tJfd� sr'g�.4ct � <br /> �l I, <br /> �— �o�c $�'�� 3 c,��noP�/ �•c,in.S 14,wN Sr`J 1 <br /> 1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Cas range <br /> Clothes washer Clothes dryer <br /> Laundry tray R2nge hood <br /> Sink(service/bar/mop/elc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 7105 <br /> I hemby centify that I have read and examined this application and know lhe same lo be true and correct All provisions ot Iaws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authonty to violale or cancel the provision of any other state or local law regulating construction or the pertormance of <br /> construction. That 1 am aulhorized by the owner of this property to perfortn the work for which application is made and I comoly with the <br /> State Contractors Law 18. 7 RCW and 296100 WAC. <br /> iy� I �-IS-�S <br /> Signature of Owner/Contracror/Authonzed Agent Date � Z <br />