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RIVIIT APPLICATIC,nI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.Drg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />1 SC 'erg. Iva (Oh <br />S � - <br />LEGA LOT NO. <br />LOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />.71rL1 ie-n.l+r—H fL�a:- 9ks vv•�:i vIISF. Cvrre-4iJA Eyu"efIy CUAqSdOX 972-bi?-3'I <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />1ucs��� rlin_a <br />I iranV., (jc.,h�a��S yA5330 -A11r0 <br />CUNTRAC R _ J ADDRESS_ CITYIZIP PHONE <br />f3gtrTs;yn�ehu��e.s Itr�llBo}hcu-L'vekiSHw�#If13�) �,1,IIer��R, 6JA 58e1a- <br />CONTR.LICENSEk BQi S>:s*-g40P�- <br />y�5-32t1-,YI(r0 <br />USE BUILDING <br />HEAT SOURCE <br />_ <br />CONTRACT PRICE OF WORK <br />`OF <br />PE 4[O I <br />_Electric _Gas _Other <br />4� 7 40, 00 <br />WORK DESCRIPTION <br />InS}LiI' O-L1111CI Ie.4kr ��SQILiN� <br />1 <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 />Forced air systems <br />— <br />— <br />Lavatory (wash basin) / <br />Shower <br />_Gas <br />piping <br />Water healer <br />Kitchen sink 8 disposal <br />Gas fireplace <br />— <br />Dishwasher <br />� <br />Gas range <br />Clothes washer <br />Clothes dryer <br />tray <br />hood <br />=Laundry <br />Sink (service/bar/rno etc.) <br />Exhaust fan <br />Backflow preventer <br />=Range <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />— <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify 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 16.27 RCW and 296.200 WAC. <br />ca �lalo� <br />Signature of Owner/ConlractrdAuOrodzed Agent Date <br />is <br />D <br />P" <br />