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PERMIT APPLICATION <br />CITY OF EVERETT PERNII T 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 />-V6fe11 �d, A <br />PARCEL TAX I.D. # <br />PE T # <br />/ 7d� 3l <br />Noz s, <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DEE <br />OWNER / ADDRESS CITY/ZIP PHONE <br />ST`IiD�AST /�Vrre/% /Ikll LLG <br />TENANT NAME <br />D,5 TT_ <br />CONTACT FOR PERMIT PHONE <br />p�,� �rn�lf ;y5)�Z�Zy� <br />CONTRACTOR MER17- MrcygN/c DRESS y630 /f3'4t•Q.r KCITYIZIP ^ PHONE (N2>�6fli- <br />�(cdnao:� k/:' 9zz4 <br />CONTR. LICENSE# Mrl RI.7"MZ163 CM <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Q I <br />k <br />' `0-- r <br />_ Electric —Gas —Other <br />WORK DESCRIPTION <br />iNs),?p ol,,syskm oN VAC- L) <br />�r�51=r 11 y' ee�1�Ns exG,,z4/ lrqnNS. 1nr5%4jl 3 <br />PLUMBING <br />MECHANICAL <br />NO. TlPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — airhandlingunits <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink & disposal <br />Gas (replace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/barlmop/etc.) <br />E_ <br />Exhaust fan <br />_ <br />Backflowpreventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Pnofdrains <br />Woodstg�yye <br />Other <br />Other <br />-704- "ti D . <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 310S <br />I hereby centify 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 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 />construction. That I am authorized 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 RCW and 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />11 <br />