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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 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />1%05 CVtR0T`r MALL WAY $T '0 <br />1QPT3IQIn0g04100 <br />Q _ <br />LEGA LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION If r� �,,x <br />T:G R`f�5 S1(6QSc N5"m (Xe! <br />DESC. <br />OWNER DURESS CITy21P PHONE <br />t'u' 1344 UENiu2A 13LVD "o 51 ; 9 4�34K5r �,t25)�t43-� <br />£V6V,F,TTMAa-1- 01 <br />TENANTNAME <br />AFRTj SAFGER- <br />CONTACT FOR PERMIT PHONE (VZS)9,91''LLp2, <br />5kFRT ShFDER <br />d,VY LAB TEST Wpw <br />EMAIL Sq�Cler,yq�r�Qtm�srn . <br />CONTRACTOR ADDRESS CI IP PHONE <br />IaN Nu6HC5 5R LD�2d� f44i71 L55RQUAN HoG�T2s {tDSC- 2s3)653-�173 <br />CONTR. LICENSE# T-SSAQLkANr WA gcU?-7 <br />w1{Iau6ac.1�TN12 <br />_ <br />USE OF BUILDING <br />HEAT SOURCE <br />- NTRACT PRICE OF WORK <br />i7 ` <br />5ce - Vt``�- I�e�t4 TrTnOX <br />_ Electric � Gas _ Other <br />4 wj* <br />WORK DESCRIPTION <br />AAA (3) 4',P0113 Wr;115/ 331F Qr ml\ ✓Jells/ sihk� N zl«,„�1 otirl�fs— <br />j:VI4t ^I`OV- -rev'c,nr- 1vw�,ovtv,' vtr— Ovi <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C - air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />_ <br />Water heater <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clotnes washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />JE <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />_ <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodstave <br />_ <br />_ <br />Roof drains <br />_ <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 />constr ction. That I am authorized y the owner of this property to perform the work for which application is made and I comply with the <br />ate tract Law 18.2 W and 296 200 WAC. <br />l khoo4 <br />Signature f wn r/ tractor/Authorized Agent Date <br />ll Z <br />