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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 ADDRESS <br />'d, <br />PARCEL TAX I.D. N <br />PERMIT IY <br />702-/3 <br />W.GAslre <br />?_10 12GYo41-^11 <br />LLGAL7 LOTNO. <br />BLOCK <br />TRACT <br />DESC <br />OWNER ADDRESS CITY/ZIP PHONE <br />ntn{� Eyerdt (,ommurilY G�nUrch l W. Canine ��er�ii +bZ64 .425 351�-Z <br />TENANT NAME <br />CONTACT FQ PERMIT PHONE <br />NOrA �r1In <br />�_ani+C11 A.y 1h.k 61'; (nc 41-5 311-5617 <br />CONTRACTOR ADD ESS CITYIZIP PHONE <br />GvOner (DhrrGiot� <br />CONTR. LICENSE a <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />.�i H ur l 1 I <br />Electric Gas —Other <br />— — <br />; 5 O Oct es <br />WORK DESCRIPTION <br />gaw ree -'40tN iiYXI hl9n (04) (IIur"-1YIC+c�1> <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />_ <br />Water heater <br />_ <br />Kitchen sirik 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (servicebarlmopletc) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />Unncl <br />Unit heater <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodstove <br />_ <br />Roof drains <br />_ <br />Other <br />_ <br />_ <br />Other <br />CITY OF EVEni­TT LOCAL SALES TAX CODE 19 7105 <br />I 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 />ordmaces 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 Contractris Lew 18 27 RCW and 298 200 WAC <br />2- l3 -a7 <br />I na ure wrier rector ut oni gent ate i <br />