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PERMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 93201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 3 —� <br />SITE ADDRESS A� LC / <br />PARCEL TAX I.D. # PERMIT # <br />3o,-;,e.6����fif <br />G�� 73J-1J66'10 Co�j2 0� <br />LEGAL �/ LOT Nq. <br />DESC. -Ir "TA1I-ft(� <br />BLOCK <br />)'1J'0-uo <br />TRACTOR SUBDIVISION # <br />Fv.eve-h Pit,- E <br />OWNERADDRESS CITY/ZIP PHONE qv i7c j-7 <br />^ <br />17T R tI co 7f �t4'%vz- <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE Lj2--Jy7o-/JJ2 <br />Q4iic/ RzQG44 IG 17J- Az ec.he A 11( <br />E-MAIL <br />CONjBQCTR �(w6AVah� jrh ` CITY/ZIP f, PHONE <br />3J//(( hVef�iMeor� i_LC. ... (.GMFlrcl <br />CONTR. LICENSE # 9f•-Li-L <br />If z <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />L � /C, X <br />t <br />_Electric Gas _Other <br />01 OG 0 <br />WORK DESCRIPTION <br />I�c?h�v L-,Xif hA- 2 14/e P--Al .V�ri(G� 4—�I hft! 4s — <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C - air handling units <br />! <br />Bathtub <br />Forced air systems <br />Gas <br />Lavatory (wash basin) <br />piping <br />Shower <br />Z <br />Water heater <br />2 <br />Kitchen sink & disposal <br />�L- <br />Gas fireplace <br />Dishwasher <br />2 <br />Gas range <br />2 <br />Clothes washer <br />Clothes dryer <br />2 <br />Water heater <br />2 <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow preventer <br />Heat pump <br />0 <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />a <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 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 />ordinaces 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 slate 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 18.27 RCW and 296.200 WAC. <br />Signature of Owner/LJontractorlAUtnorized Agent Date <br />I <br />/ Z� <br />