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08/25/2039 00:44 42EB140301 FAIRFAx <br />PAGE 01/05 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />i,r\\ <br />425-257.8810— FAX 425.257-8857—www.evereMya.org <br />Vvv <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITG ADDRESS <br />�v��6rz✓�N <br />PARCEL TAX I.D. R <br />P aso5 <br />-E <br />LEGA. LOT NO, <br />BLOCK <br />TRACT OR SUBDIVISION If <br />DESC <br />OWNER ADDRESS CITYrZIP PHONE <br />nu�,Q 693iR <br />TENANTNAME PHONE ao6-9q9-�C`�69 <br />,�CnONTAACTFORPERMIT /� <br />``o,•� f(' C�� ,\�i�1\S `�L�-)CI\o���\NCJ E-MAIL <br />ak) a�e-0Lk" PHONE Ao& 999 BIjm' <br />ooNTR.�UcIF\TT ��'z 1 a 5� 98 00� <br />USE O�F�BUILDING <br />HEATSOURCE <br />CONTRACT PRICE OF WORK <br />X Electric _ Gas _—Other <br />WORKDESCRIPTION <br />SPrk <br />C31�i� ROD Y`/1 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF nXTURE OR ITEM <br />No. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />AI'C—air handling units <br />_ <br />Balhtub <br />_ <br />Forced air systems <br />T <br />Lavatory (wash oasin) <br />_ <br />Gas piping <br />Water heater / <br />Shower <br />_ <br />Kitchen sink a disposal /O <br />J` <br />_ <br />Gas fireplace <br />Dishwasher <br />Clothes washer , '-0 <br />Water Ineater v G ONLY J" <br />_ <br />.,,-_ <br />Gas range <br />C'oiltesdryer <br />hood <br />Sink (service/bar/ opletc,) <br />_Range <br />Exhoustfan <br />Heat % <br />Backaow preveerriter <br />Urinal <br />Ormki� / <br />ng Folfntalr <br />_Boiler <br />pump <br />Unit heater <br />Floor drat99� <br />,� <br />Refrigeration <br />— <br />Grease rSp <br />Roof d dins <br />_. <br />Woadcrovd <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX;�ODE IS 3105 <br />1 hereby cerlUly that I have read and examined this applicaton and know the lama to be true end correct. All provisions Of laws and <br />ordinates governing this type of ,York will be complied with whathcT specified heroin 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 an authorized by the owner of this property to perform the work forwhich application is made and I comply with the <br />Stan Contractors Law 18.27 R 296.200 WAC, <br />End <br />rgnature Ot rwrZontraCtor/Autlxad Agen Dals <br />'a <br />1W <br />`L <br />