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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES 6 _a4 /v <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />AM TO 4 PM r(l% A� <br />APPLICATIONS ARE ACCEPTED FROM B <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />$5 - *10t <br />�- <br />LEGA LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />TAN A/!d)Yrw / 35- SE FVEPL-,T- MRI.L I JAY ri 1p l C VEk TT- CIUn g <br />ISO 12.Ab <br />TENANT NAME CONTACT FOR PERMIT PHONE &0&_ g <br />j �ft)1,/(t JY N TR.1 Al+ )YEN E-M_A_ILGTS/C� l� YI1NAi• GOM <br />-"#N ADDRESS CITYIZIP rnvn� <br />R <br />r4DVAA/CE6 5ICrN „1cpt A)E IeH '51- ON gSOSG ,f06- 5�50-It4Q <br />CONTR. LICENSE # // /.� <br />AI)Vf+A bf- UI -- <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT/PRICE OF WORK <br />_ Electric _ Gas _ Other <br />WORK DESCRIPTION <br />51V9f FRANT sicTA� <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 />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />_ <br />_ <br />_ <br />_ <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />_ <br />_ <br />_ <br />_ <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />_ <br />_ <br />_ <br />_ <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 />ordinances governing this type diwork will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate of cancel the provision of any other state or local law regulating construction or the performance of <br />the for application is made and I comply with the <br />construction. Th m au )prized by the owner of this property to perform work which <br />Slate Conlracto s w 18. 7 RCW and 296.200 WAC. <br />Signature of 0 ner Con ractor/Authorized Agent / ate <br />