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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 - vnvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS Parch 115 <br />PARCEL TAX I.D. # PERMIT# <br />I —D�L <br />1402, S.If. Everefi Mall Wa <br />YM D2&) <br />LEGAL LOT NO. <br />_ <br />TRACT <br />717�BLOCK <br />DESC. <br />OWNER ADDRESS CITYl71P PHONE <br />-C NE sfc- NFAS-r a0zH1 5W 611764 57. NewQopl 3ePeP <br />TENANT NAME Cr1lJrnrr cno PHONE <br />�NL I`IJI"ay IpvLIt r 411,- 338 - sg�s <br />CONTRACTOR Dcld IUIIA COAS}rJC1-10p DRESS CITYOP. PHONE <br />blWe+-� I�IL� aolso A E sgv (1t Ro y �wA / d r3. 606• S <br />,�'8?'ii <br />CONTR. LICENSE U�c �� C• ls5sU �(�lt�12as3-e43- <br />USE OF BUILDING HEAT SOURCE C NTRACT PRICE OF WORK <br />�F <br />/"IP,YC4,nf7 �2. Electric Gas Other <br />WORK DESCRIPTION <br />—4�'thO-�Ctw'FI CS nGtLro top unI'Y z la.:n���l-ofl-r`%-�$ _. <br />J <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C— air handling units' <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />Water heater <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow, preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <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 applicalioo 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 cr 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 1827 RCW and 296.200 WAC. <br />Q4::!�r z-/J�P 7 <br />Signature of Ow ctorn� Datez <br />�ja <br />a4 <br />