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I, <br />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 <br />SITE ADDRESS <br />y / L/ F d era l Ave <br />PARCEL TAX I.D. X <br />00 5937 00 000 0 2. <br />PERM T # <br />C o -ova <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />0 0 <br />OWNER ADDRESS CITYIZIP PHONE 14Z5 76CI IV05 <br />Penn. I laferS t121LA FederA,] &e tFAfWe# 98zo3 <br />TENANT NAME CiONNTACT FORPERMITPHONE L426 78y 1/40� <br />P PG+erS i.q( hMwi1. <br />E-MAIL <br />CONTR-AMR ADDRESS P <br />CONTR. LICENSE # 0 W n 'e r <br />OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />jU�SE <br />l`�' 3�(]e/�Le I <br />_Electric _Gas _XOther <br />00 ooa <br />WORK DESCRIPTION <br />I�ernod2� E1CLS-rIAJ& �}ruCi ure_ <br />4"("'/' '/ z "/- s�) <br />_ <br />PLUMBING <br />MECHANICAL i <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toil,, <br />_ <br />A/C — air handling units <br />Bathtub <br />_ <br />Forced air systems <br />Lavatory (wash basin) <br />Shower <br />_ <br />Gas piping <br />Water heater y <br />Kitchen sink & disposal <br />Gas fireplace <br />-J_ <br />Dishwasher <br />Clothes washer <br />_ <br />Gas range <br />Clothes dryer <br />—L <br />L_ <br />Water hnater <br />Sink (service/bar/map/etc.) <br />Range hood <br />Exhaust fan <br />_ <br />_ <br />Backflow preventer <br />Urinal <br />I <br />Heal pump <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__ <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 stale or local law regulating construction or the performance of <br />const . That thorized by the owner o(this grope ly to pe form the work for which application is made and I comply with the <br />S e Contr etors Law .27 RCW and 296.200 WAC. <br />, / ' <br />lure o ier/Contractor/Authorized Agent D• e I f�� <br />