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r-'ERMIT APPLICAI iON <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 rlbGC_J <br />PARCEL TAX I.D. #Iortg: <br />SITE ADDRESS <br />LOT NO. TRACT <br />t� `(1 <br />OWNER ADDRES CITY/ZIP P ONE <br />pam� 1c ) L aLa;A 1 oc�c�xo�rl 1'c� l 9n \<z R, l=��r�l�-(Ah 9 <br />TENANT NAME <br />��' <br />CONTACT FOR PERMIT PHONE <br />puit?_\ �a 3 < � -e.cn <br />,2j <br />COOR r ^�ADDRESS CIT(21P PHONE <br />CONTR. LICENSE #V-�\ a '� (�J,�� �tty� VALU Q6 DUx <br />Pip 1 <br />USE OF BUILDING <br />HEAT SOURC= <br />I CONTRACT PR C - OF WO <br />1 Cam— <br />1 <br />_ Electric _ Gases Other <br />WORK DESCRIPTION` <br />�n 1 <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 />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />_ <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />_ <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />_ <br />Range hood <br />Exhaust fan <br />_ <br />_ <br />Back(low prevenler <br />Urinal <br />Heat pump <br />U1 heater <br />_ <br />Drinking Fountain <br />Floor drain <br />__ <br />Biter <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Wbodstove V <br />Ot�er <br />_ <br />Roof drains <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3 05` <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 />co uction. 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 />ate ontractor 18.27 RCW and 296.200 WAC. <br />S. - S <br />Si Lee e ner/Contract r/ u o ze Agent Date <br />I_ - <br />