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APPLICATION <br />PtRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES i�_�6—�S <br />CITY OF EVERETT PERMIT SERVICES (/_lb-�.S <br />9200 CEDAR STREET, EVERETT. WA 99201 <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />42525]-8810 -FAX 425d5]�885➢- www.evereltwa.org <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />APPLICATIONS ARE ACCEPTED TO <br />L <br />SITE ADDRESS / n I PARCEL I.D. PERMIT <br />SITE ADDRESS I— �� PARCEL TAX I.D. # I PERMIT # <br />ryv� <br />R L � <br />.[� _IF—JiT"r/` I\d <br />Lei NO. <br />LEGAL LOT NO. � <br />LEGAL <br />oast. z <br />OCF <br />BLOCK <br />BLOCK <br />TRACT <br />i0.PCi ( ^I^ <br />I2oz-R-© <br />DESC. <br />) �� <br />CS <br />qy�p ao acs3 einrsv rxoxe <br />OWNER ADDRESS CITYIZIP PHONE <br />µ;al<..Q�A-vraso E�o.d- a 19 <br />I�;G1��- C„- q�2o <br />TENANT NAME <br />TENANT NAME <br />iARFO PERMIT PHONE <br />CO TACT FO PERMIT PHONE <br />• <br />I' <br />CONTRACTOR ,NCn'!ADDRESS 'a �e�ITY21P PHONE <br />CONTRACTOR `uLrt' �bt� 0.?E55 am��ILY21G PXIX1E <br />CONTR. LICENSE #) �� r•' <br />oxm.�wexsEA µILLC.e Rip qL `�• ' <br />� z0 �� <br />USE OF BUILDING <br />USE OF BUI•L�DING <br />�IJ <br />HEATSOURCE <br />HEAT SOURCE <br />_Electric ✓as _Other <br />CONTPPCI PRICE OF WORK <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />WORK DESCRIPTION <br />C 24W� SPAc� 8EI i GaaPGE A-( 645bM£v�1 LflVFi <br />C2gW� SP�ac� �)il1Gp C�afzl�c,E 13AS�M.rt1 LF_yEt_ <br />PLUMBING <br />PLUMBING <br />MECHANICAL <br />MECHANICAL <br />NO. TYPE OFFViVREORIIEM <br />NO. TYPE OF FIXTURE OR ITEM <br />TYPE OF FUINflE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />TNIA <br />Toilet <br />lJC—th M1in9iy units <br />A/C —air handling units <br />Bathtub <br />Bathtub <br />Famtl air systems <br />Forcedairsystems <br />Lavatory (wash basin) <br />Lavatory (wash basin) <br />� <br />Gas piping <br />Gas piping <br />SMxtt <br />Shover <br />L <br />Wafer heater <br />Walerheater <br />Kitchen 9nkBE'u�osM <br />Kitchen sink &disposal <br />I <br />Gas fireplace <br />Gas fireplace <br />( <br />�. <br />Dishwasher <br />Dishwasher <br />Clothes <br />Clothes washer <br />I <br />� <br />� <br />r <br />� <br />Gas range <br />Gas range <br />Clothes dryer <br />Clothes <br />Range M1ootl <br />Range hood <br />Laundry <br />Laundry tray <br />Sink (svWmNarlm�p/ele) <br />Sink (service/barfmop/etc.) <br />{p <br />� <br />Exhaust fan <br />Exhaust <br />BavXAow gevmlx <br />BackBow preventer <br />_Heal <br />Heal pump <br />pump <br />_ <br />Viral <br />Urinal <br />_Unit <br />IINI heater <br />heater <br />_ <br />OlrMJy Fountain <br />Drinking Fountain <br />Bolles <br />Boiler <br />_ <br />F!oor drain <br />Floor drain <br />_Refrigeration <br />R¢hgeYelgn <br />_ <br />Grease trap <br />Grease trap <br />WwOslwe <br />Woodslove <br />_ <br />Roof Jnim <br />Roof drains <br />_Other <br />Olhx <br />_ <br />Other <br />Other <br />CITY OF EVERETT LOCAL SA _ES TAX CODE IS 3105 <br />CITY OFfl/EREii LOtOL5P.E5 ihY CODE <br />I IIBreEy cen4ty1M1s111ara tteE and examined this application and know the same to be true and correct. All provisions ollYN53nE <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />old'n0m50�mi� this ry� of work will be complied with whether specified herein or not. The granting ola permit does not presume <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 WNonty to violate oruNSI1M pNVKbna(anyolM1a state o�bal4w regulating construction or the performance of <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />w wtpn. That am authorized �ymeamermims o�neM �o penammewonmrvnim application is made aneiromoNwi�n�� <br />constru tlon. That I am authorized by the owner of this property to perform the wor!: for which application is made and I comply with the <br />Sole nlrecWs 192]RLW entl R610J WPC. <br />Stale ntractors a 18.27 RCW and 296.200 WAG. <br />/� <br />Signature CwnetlConPaUotlNUN.AzeOl�gen� a <br />Signature of Owner/Contractor/Authcdzed Agent <br />I/ y� <br />r �J <br />PERMIT <br />