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PERMIT APPLICATION <br />CIT( 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 PARCEL TAX I.D. 0 PERMIT N <br />2 G2V <br />yrer�co D 39l 2 aze a� oiz_ <br />LEGAL LOBLOCK TRACT OR SUBDIVISION 0 <br />DEsc. 2u61 <br />3 D'Ud — <br />OWNER ADDRESS CITY/LP PHONE <br />CIY3/ .I' wdmrre M// . 'f5 Zq 9h f - f fO <br />TENAN NAME CONTACT FOR PERMIT PHONE �Z5.215y.3316 <br />, 1 <br />M.A. keiji 5M h11) �ef� E-MAIL <br />—zTry zjp <br />7/? b <br />CONTR. LICENSE 0 <br />USE OF BUILDING HEAT SOURCE -ONTRACT PRICE OF WORK <br />Lr bVA t X_ Electric . _ Gas _-_ Other 1�7q/ i/7''I� LV <br />WORK DESCRIPTION <br />S <br />I,�� 5F rm" f Irri�✓'v% ram( I` 1 T <br />&"a lh>ww <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />Toilet ____ A/C - air handling units <br />_ Bathtub _—_ Fol ced air systems <br />____ Lavatory (wash basin) __ Gas piping <br />Shower Water healer <br />Kitchen sink & disposal __-_ Gas fireplace <br />____ Dishwasher ___- Gas range <br />Clothes washer Clothes dryer <br />_ Water heater Range hood <br />____ Sink (service/bar/mop/etc.) Exhaust fan <br />Backilow preventer Heal pump <br />_ Urinal __ Unit heater <br />Drinking Fountain __-- Boiler <br />Floor drain -___ Refrigeration <br />Grease trap ___- Woodstove <br />--- <br />Roof drains ---- <br />Other ------ — <br />---- Other -----------'--- ---- --------------- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinances 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 />construction. That I am authorved by the owner of this property to perform the work for which application is made and I comply with the <br />Stale ntractors Law 18.27 RCW and 296.200 WAC. <br />Sig lure of Owner/Contractor/Authorized Agent Dale la <br />