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i <br />PERMIT 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 />ZIL4 k <br />PARCEL TAX I.D. # <br />PERMIT # <br />LEGALI LOT NO. <br />DESC. U • Zl <br />BLOCK <br /><1.33 <br />TRACT <br />�ua� OF a�- <br />OWNER Z ADDRESS CITYMP (IPHONE <br />�� <br />Ko?)a iu'l 6,4. -LN 03,1, JUL L, Lc� 4ZS.193 <br />'ill <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />I okra-. <br />CONTRACTOR D ADDRESS CRYlLIP PHONE <br />IJI,�;L <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I <br />—Electric _ Gas _ Other <br />I <br />WORK DESCRIPTION <br />IZD s' /N Nsai0,V <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 />Laundry tray <br />_ <br />Range hood <br />_ <br />Sink(servicelbar/mop/etc.) <br />— <br />Exhaust fan <br />_ <br />_ <br />Backflowpreventer <br />_ <br />Heatpump <br />Unit heater <br />Urinal <br />Drinking Fountain <br />— <br />— <br />Boiler <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />— <br />Woodstove <br />Other <br />_ <br />Roof drains <br />— <br />Other <br />— <br />_7 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that 1 have read and examined this application and know the same to be true and correct All provisions of laws and <br />ordinaces goveming 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 ovww1M+9er of this property to perform the work for which application is made and I comply with the <br />:State z19.2��d�60WAC.1, ��n <br />' atura of nor/ 'on ctor nzzzed AgentDate 1h <br />C�b <br />