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--Q 9 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PER nn n <br />,35 SF ��1L'2CTT MAL� w9.� <br />Onr-/$OZOIj 003y1 - <br />� (lGJ — <br />LEGA LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION # <br />DE SC. Z <br />1 3 <br />SnjF(cii'"1 AC(d (ily <br />OWNER ADDRESS U CITV2IP PHONE <br />Il:ID4 ASI� w.y ZL'j r,�� A Zs -74/-3SIf <br />l.yrn� H <br />Ec./c�-8AQ4F2-EvG2r,� ra�it�wAyuc ys<<o5� <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE 5Av.n i{ <br />i Ge��e-l3ARl,Ea (�Rt,�PE27sCs, <br />T�n Ferlr �-r3RQGr i� <br />LLEMaLTovnC'&dAF�BA�i�r�/Ce��'�" <br />CONTRACTOR Noy rEr ('F/c5[,J ADDRESS 7/�--'7 'TOG <br />CONTR. LICENSE # <br />, <br />USE OF BUILDING <br />HEAT SOURCE � <br />CONTRACT PRICE OF WORK <br />OFF f � E <br />Electric 'Gas Other <br />O cc <br />WORK DESCRIPTION <br />/ S5 Snl UNST- 1D1 !)f- <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />i I <br />Toilet <br />AIC — air handling units <br />_ <br />I <br />Bathtub <br />_ <br />Forced air systems <br />_ _ <br />Lavatory (wash basin) <br />_Gas <br />piping <br />Shower <br />_ <br />Water heater <br />_ <br />Kitchen sink &disposal <br />Gas fireplace <br />ishwashcr <br />Gas range <br />thes washer <br />Clothes dryer <br />W rhoater <br />Range hood <br />� <br />Sink ervice/bar/mop/etc.) <br />Exhaust fan <br />Backll preventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />Drinking Fo lain <br />Bailer <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />_ <br />Root drains <br />Other_ <br />Other <br />CITY OF EVERETT LOCAL SA! -ES 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 />ordina;,es gover, sing 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 Iccal law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to pedorm the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 206.200 WAC. <br />1 2-N-o`7 <br />Signature of Owner/ContractouAuthonzed Agent Date / <br />1 <br />Z <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />1200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 —FAX 425-257-8857 — www.evere'twa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 3 -(o <br />3 <br />