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PcRMIT APPLICATRA <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, E v i=RETT, WA 98201 <br />425-257-8810 -- FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br />1 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />-)o o �V �n�R�-�N w Y <br />ab� So -)I 0 3u0 <br />- <br />LEGAIJ LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE "7til J-,3J� <br />o o►J f Farn t t_`f �`13a i= VL_�6f2L'Li\i �JA i k.UI:ZLr `k53 i <br />TENANT NAME <br />CONTACT FOR PERM❑ PHONE aO U <br />\A �� Q W C K <br />� <br />N LZ - E-MAIL <br />ONTRACTOR ADDRESS pL tJ1_ CITY/ZIP PHONE <br />TV1 QiL Ro )� (Z I roal ) agTpr� itas q aa- <br />/� Qp <br />p <br />CONTR.LICENSE#,W`CT�,O Y'-1 �. -I C) P, 1��I��Ln I003 Z IZ/3/D�7 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />RL T R I, L_ <br />Z_ Electric _ Gas _ Other <br />I <br />) I O O 4:�a. a Qt <br />WORK DESCRIPTION <br />R� Uoc�-� ��= rcnstrrzS rrosr►aLL <br />Tvx� NL=W I W a P,YYNOS Y I S <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C - air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (servlcelbar/mopletc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow prevenler <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />RUrigeralion <br />_ <br />_ <br />Grease trap <br />Roof drains <br />Woodstovo <br />OthlE &Lsz�C1aTL- <br />Other <br />_ <br />_ <br />�— <br />I ros i f>u TI Jo1 A <br />"TN1_�' <br />' CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces 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 />Stale Contractors Law 18.27 R W and 296.200 WAC. <br />J V <br />Signature of Owner/Cont ctor/Aul orized Date <br />