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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425 257-8810 - FAX 425-257-8857 - www.ev,!rettwa.org / � 3 - OCY <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �J �� _ pC7 <br />SITE AD.1?RESS <br />p� <br />PARCEL TAX I.D. 9 <br />cxs3 29000c a /0 1 <br />rjJc 37900 O_Q_p/n;J <br />!ERMIT N <br />�` •��� - �� <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION G //-� <br />n <br />DESC. <br />>7 I ZUZ (X iO <br />OWNER ADDRESS CITY!ZIP PHONE L-1;I <br />f�,ex LC iff� � <br />1j'�44 S O' (� /`'3')3 Oelflow v1. e7veve-+ tv't %&iV`,+ 8(b7 <br />TENANT NAME CONTACT OR PERMIT PHONE <br />2007 <br />E-MAIL �V 6PV'0 <br />CONTRACTOR ADDRESS CITY!ZIP PHONE <br />0'V K e v ' <br />CONTR. LICENSE A , <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />_ Electric C Gas Other <br />WORK DESCRIPTION <br />_ <br />u1 r,%> <br />(46 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />4-Y <br />Toilet <br />A/C — air handling units <br />3 <br />Bathtub <br />Forced air systems <br />S <br />Lavatory (wash basin) <br />Gas piping <br />1 <br />Shower <br />Water heater <br />/ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />/ <br />Gas range <br />Clothes washer <br />�(_ <br />Clothes dryer <br />Water heater <br />I <br />Range hood <br />Sink (service/bar/mop/etc.) � jj. <br />19 tS <br />Exhaust fan <br />Heat <br />Backflow prevenler !fir F N <br />pump <br />Urinal 76 <br />Unit heater <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 />ordmac�s overning this lypcwork will be complied with whether specified herein or not. The granting of a permit does not presume <br />the state local law regulating construction or the performance of <br />le or ca. el provision of any other or <br />to giv=tt1 ority to(aw <br />consjrucli0n. Thataulhoded by the ovine{ of this pi, perty to perform the work for which application is made and I comply with the <br />Staled onlractors8.2YRCWand 6.20� WAC. <br />' 7 <br />/ <br />Dale <br />Sig lure of Owner/Co actor/A.uth riz gent <br />n / <br />V <br />