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9-1 <br />PcRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — vvww.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM G �� <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERAVT # <br />70)0 NAY <br />ago���o t300 <br />90%'Z <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />OL_sorJ j Yarn C�93a laid t='�6QC--C- o WAY t_=_U IT /+a6-��3 `f <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE �0 G-9 q 4 - fi0 6g <br />y� {� <br />. ..`-A(z..t`. FLOC. IC <br />\ r\i <br />W�( NLr— 1� R7 S EMAIL <br />CONTRACTOR /n� // ff�� ADDRESS �7LL /gyp CIT=IZIP PHONE <br />ikm 01 fv u 1', Q . 4ox 1 / T r)AQ1 1' I Cr �AA a� — 7 35_ l3q <br />* <br />CONTR. LICENSE #PL- <br />�'y pw,c ()Q/3 zztL/) <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />R�=TP 1 L— <br />L Electric _ Gas _ Other <br />I <br />I <br />WORK DESCRIPTION <br />13 t&j L_t�> ra �a f� r-�TH Room P\ N Q Yro V 1✓ <br />t=xf 5T ) Qb 1A W N <br />PLUMBING <br />MECHANICAL <br />TYPE -OF FIXTURE OR ITEM <br />NO. <br />TYPE OF FIXTURE OR ITEh1 <br />Toilet <br />_ <br />A/C — air handling units <br />Bathtub <br />_ <br />Forced air systems <br />= <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 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 (service/bar/mop/etc.) <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 />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />= <br />Roof drains <br />Other T\No\l L IJ (J H <br />Other _ <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 />ordinates governing this t; a 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 authorizeo 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 RC ad 296.200 WAC. <br />JZi II <br />Signature of O r/Conlrac r/Autho 'zed Agent Date <br />03 <br />