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� <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 />PARCEL TAX I.D. # <br />PERMIT # <br />'C 10 I i II Q <br />OD 3 194 D <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION p <br />1 <br />DE"C. <br />Sli1 t / ADD tQ s 1`ULRCL7T- t.eA <br />OWNER ADDRESS CITYIZIP PHONE <br />C C& i � Ct, 11 T e s t L��J,l�tiod�i Eve�r.�1 y aao l a a c- 1pH � o <br />TENANT NAME <br />COIN CT FOR PERMIT PHONE <br />�" <br />LfAIA 1.-�w l IIFJ <br />SS <br />m�KQ. i.GCSC.n E-MAIL ti25- 3%7-as <br />� 1 ACfUR'�' A66FES5 �1 CITYIZIp PHONE <br />LArSe.n CL)n5� g(opo 002 r✓cak f8�6'1 4,a5--3d-7-a5-3•5' <br />CONTR. LICENSE A <br />LAR.SG< � lot DH <br />USE OF BUILDING <br />HEAT SOURCE <br />PRICE OF WORK <br />t � <br />_Electric X Gas —Other <br />jrNTRACT <br />CIOFSlden�la� <br />�� <br />WOR" DESCRIPTION <br />Rtrrai-I kr �' and OJd be�rccrn 4 brA 17Qry ac01440 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />� <br />Toilet <br />Fv'C —air handling units <br />� <br />Bathtub <br />Forced air systems <br />� <br />Lavatory (wash basin) <br />_Gas <br />piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink &disposal <br />Gas fireplace <br />Dishwasher <br />_Gas <br />range <br />Clothes washer <br />� <br />Clothes dryer <br />_ <br />Water heater <br />� <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc,) <br />'A_ <br />Exhaust fan <br />_ <br />Backllow prevenler <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />_Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 />ordinaces 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 authorized by the owner of this {property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and298.200 WAC. <br />L7—Z:�ZC /-) -CJ -CIS' <br />Signature of Owner/Contractor/Authorized Agent Date 1/ <br />Z <br />