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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 _'Ot� /OCO <br />PARCEL TAX I.D. # T <br />PERMIT # <br />1907_ SE EVOZE7 K*t.A­�-t <br />Z�s) Soo 4oi 5-o© <br />�a 5-G <br />LEGAL LOTNO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />5;�7k F0114)- iEUMa-7 >c�u uc 4 3y� Vag! gkIT NZpwPLv�n�- a tu+ <br />uE R <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />-IUSi SpGlL7 S <br />I HI Ni4 VA01QI�-rf20 14j= V3 -17224 <br />CONTRACTOR Nlgl+ ADDRESS CITYIZIP PHONE <br />M�lr <br />CONTR. LICENSE # 9"0 !S3' AtledE A&DI rOnl?) yZS-Yg-:3 _' uy <br />9PO73- <br />_ <br />USE OF BUILDING I HEAT SOURCE I PRICE OF WORK <br />O <br />,CONTRACT <br />�-- Electric Gas Other TI <br />— <br />WORK DESCRIPTION �U�-(,�/OQ �� /�✓yS/O!�l <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />— <br />Toilet <br />Bathtub <br />A/C — airhandlingunits <br />_ <br />Lavatory (wash basin) <br />_ <br />Forced air systems <br />Gas piping <br />Shower <br />_ <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 />Laundry trayy_ <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Bacpreventevenler <br />_ <br />Heal pump <br />— <br />Urinal a) <br />_ <br />Unit heater <br />— <br />Drinking Fountain <br />_ <br />Boiler <br />Floor drain <br />_ <br />Refrigeration <br />— <br />— <br />Grease trap <br />P <br />Roof drains <br />— <br />Woodstove <br />OlheryGiWOl rJ�lG <br />Other <br />/IFr//Sion/ <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 />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />or cancel the provision of any other state or local law regulating construction or the performance of <br />to give authority to ?am <br />construction. Th am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State tract s Law .27 C n 96.200 WAC. <br />e f Owner/Contra or/Authorized Agent Date <br />