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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 B AM TO 4 PM <br />SITE ADDRESS S Ei` ETi _ <br />PARCEL TAX I.D. # <br />PERMIT # <br />/lt /4/�3 <br />LE LT LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />NER ADDRESS CITYZP PHONE z/25=339 3L3b' <br />ZaZ07 AViC Z�I/ZeOf wK992aI <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE y>y 353 Cl-17 3 <br />Q'eoz <br />�x2x K CO ,� E.MAII %e.L'Ge?":P5 4'eEVE.1t;T, <br />WNIKAUIUKFaAr $ t� �Lr1) SADUKESS _g TYFDP PHONE �dS <br />�a� j3�-- p�� <br />_ 1 <br />CONTR. LICENSE#;�/roA1S/o66 (�IZ- <br />�,� crra,c, vq 9fro/d <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I — Electric Gas Olher <br />I <br />WORK DESCRIPTIONC A �'IE L t— E%/E� 5 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />_ <br />A/C — airhandlingunits <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />_ <br />Range hood <br />_ <br />Sink (service/badmop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heal pump <br />_ <br />Urinal <br />Unit healer <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined this application and know the same to be true and correct All provisions of laws and <br />ordinances governing this type of work will be complied with whether specified herein or not. The granting of a peril 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._IhaLLaq authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Slate C actors Law 27 RC anj 296.200 WAC. <br />Signature of Own /Contractor thorized Agent Date ( / <br />7 <br />