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1* <br />P"tRMIT 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 <br />PARCEL TAX I.D. # <br />P M!T # <br />61 � ;5..E� W <br />?-P C)51 12�003C-} 400 <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />-1-- <br />�JIM L.1hjDA T omic H ?� g6o7L _ aox 2-225 wo0.An,tua 4L6-463-4583 <br />TENANT NAME <br />CONTACT FOR PERMIT PHO <br />L=� 'I <br />� uE;-.5 a�( PACz, 11N.G— <br />_C <br />G2AttT Tao?-D0�1 zoo-522 8`�' j <br />CONTRACTOR p COW5TR.OcT1 NO�)j INLADDRESS (0&;c wOoDLftw CITYIZIP PHONE <br />IqF- 5urm Ito ` 'A ZO`- see -6180 <br />CONTR. LICENSE# ��- <br />��rfxil l3� L� J - -\ 061 g8115 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />pp <br />4TAIL. <br />_ Electric Gas _ Other <br />5d/ 00 <br />WORK DESCRIPTION EuI-3I I l2bL <br />WT MDf 511 l k, -C)NS TQUCT OEL i O FF-tcc NF_lx) Fl Of R C.OYE{Zll\ldz- <br />iztyt�lyT cSWELvi KC. 1i(DT- akca--f--D g I• <br />PLUMBING t <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />I <br />`hater heater <br />_ <br />Kitchen sink 8 disposal <br />__ <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Water heater <br />Clothes dryey/ <br />Range hood <br />Sink (service/by/rhopletc.) <br />Exhayst'fan <br />Backflow pryventer <br />Heat pump <br />Urinal 7 <br />nil heater <br />Drinkif(9 Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I e read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governin ¢Is type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority y Elate a cat tho provision of any other state or local law regulating construction or the performance of <br />construction. T t I am lh , �y the owner of this property to perform the work for which application is made and I comply with the <br />Stale Con 7 and 296.200 WA.C. <br />I-1�-d6 <br />gnat of Owner/Contractor/Authorized Agent Date 62, <br />