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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 `0 6_0 5 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PE IT # <br />IV? di/fril7r - <br />/0 7 9 <br />Z - <br />LEGA LOTNO. BLOCK <br />DESC. <br />TRACT <br />J <br />04 <br />OWNER ADDRESS CITY/ZIP PHONE <br />`�71Eft�fL� (Ig'ok <br />?Aw( 910� 0 '-uEfg? <br />TENANT NAME <br />gwtfv <br />CONTAeT FOR PERMIT PHONE <br />I �-j L <br />GnKMyv� <br />�s� QWS�L-+ <br />udlc� L309 a9S' s <br />CONTRACTO C5F 2NCh0y 1'^1r- ADDRESS-7 (gC( f= S 0Ef ITY21P NE <br />CONTR. LICENSE # C�;£' ( //mac {y CXK4 /� 4fiA/� /(? No <br />Vj 7✓, J 07 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />((ll <br />IL <br />Electric Gas Other <br />X <br />7 wo <br />$1t) nni U'ol/1iACL <br />— — <br />WORK DESCRIP ION & (O"/ - �dablr_ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — airhandlingunits <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />sink 8 disposal <br />Gas fireplace <br />=Kitchen <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />Range hood O <br />Sink(service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backfiow preventer <br />Heat pump 50 <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration 35. <br />trap <br />Woodstove <br />=Grease <br />Roof drains <br />Other 3-5— <br />— <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />II <br />I hereby ceritify that I have ead and examined this application and know the same to be true and correct. All p� vi of laws and <br />ordinace erning this pe of,:mrk will be complied with whether specified herein or not. The granting of a p does not H: c:ume <br />to give utho ty to viol a or cancel the provision of any other state or local law regulating const uct on or the p ormance of <br />const ction hat I a authorized by the owner of this property to perform the work for which application is mad and I comply with the <br />State on ctors Sv 18.27 RCW and 296.200 WAC. <br />Sig azuris e of Own /ContractodAuthorized Agent ate <br />`I <br />