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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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />Cl/ <br />140 SE et1E0Z6'rT IrtALL W4Y <br />7 ✓� <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITyrzIP PHONE <br />2ogllSW 41RCH+ST tJewTT,(ZSgCI4 <br />STt:ADFAST uKP• sum 2zo RZGbo 99R-esz-0700 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />y GKIZo i\) <br />I & eLnL F� 42-'�- - 883- ct 22-L{ <br />CONTRACTOR MErAIT MCC µ4A1te,4L ADDRESS 96'3o 15-01>/4ve CITY/ZIP PHONE <br />NE qZs-$63.9u4 <br />CONTR. LICENSE # <br />M6QtrMl- lb3ch REDhoaO, 9�023 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Electric X Gas _ Other <br /># rg+ Zdi O <br />WORK DESCRIPTION I0Sr-4LL l GAs/e-LitTRtC {LOoF TOP t&.,tr wtrt1 Ars50G14-tc'-0 <br />41R sYsrL4A C Gyps IPIPIOC+- I1'JS7,41-t- I ct4tLttJc7 rtoAtst <br />94P wtro 4,55octA-Tkp s~x�i./cusr aw�rw�ak, 1 7 A/iY PRUG�Li9?iKtBt_E <br />TH,Q ko -.s T-A--j- <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />t <br />A/C — airhandlingunits <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/bar/mop/etc <br />7_ <br />Exhaust fan <br />_ <br />sackflowpreventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountai <br />Boiler <br />Floordrain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drai <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 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 />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 />censtruction.7hat I am authorized by the owner or this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 R W and 296.200 WAC. <br />Signatu� r�,07m Icon( r 6� orized Agent Date <br />//Z <br />