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PLRMIT APPLICAT16A 1 <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org In 06/O-o 53 <br />APPLICATION.` ARE ACCEPTED FROM B AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />3 u U <br />YMOG 10 US <br />GAL <br />t <br />BCK <br />TRACT <br />LfTiN! <br />SC. <br />OWNER <br />ADDRESS CITY/ZIP PHONE <br />RtL�L C,twnun',OC/ <br />6�jo �envwen W� To-retj' <br />_ <br />TENANT NAME/ <br />CONTACT FOR PERMIT PHONE <br />rom do <br />CONTRACTOR <br />(k0 V1 , <br />ADDRESS CITY/ZIP PHONE <br />Si.,�� W 12uZ I o Soh --203 -tv67 06 kf'S 3R4 <br />CONTR. LICENSE # <br />g 4vi> <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I _ Electric V— Gas _ Other <br />2 r q oo,— <br />WORK DESCRIPTION <br />jr, Cho (v'-r <br />1 �' 1 <br />S % Ze of�- �/, 7r1 U vj'+� � ^'� I M � 600 0 r <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />tPol <br />TYPE OF FIXP IRE OR ITEM <br />Toilet <br />�_ <br />A/C — airhandlingunits <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />^_ <br />Gas piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />I <br />Dishwasher <br />Clothes washer <br />Gas range <br />Clothes dryer <br />Water heater <br />Range hood <br />Sink (servi-e/bar6mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Floor drain <br />Boiler <br />Refrigeration <br />Grease trap <br />Woodstove <br />drains <br />Other <br />=Roof <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 />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 stale 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 Contractors Law 18.27 RCW <br />and 296.200 WAC. <br />— . U Cfzal()d <br />Signature of Owner/Contractor/Authorized Agent Date <br />