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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.everattwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. If <br />PERMIT • <br />LEGAL LOTNO. <br />DESC. <br />BLOCK <br />TRACT OR SUBDIVISION <br />OWNER <br />t� <br />NA�}b�ah <br />Ql�c.a-S <br />ADDRES 0TY21 PHONE <br />$D3S- lc"� QNe. NE >eo'L-f(e 9�-,15- aol, 5.13-`i7y5 <br />TENANTNAME <br />I <br />FOR PERMIT PHONE <br />qp.S-"(0-.L09'4 <br />Nvt 1. <br />Z <br />ppCON�TACT <br />66a �,QD�I Sr EaIIAILiYAPlpo,l. eiavHna, <br />NTRA'QQ•f <br />`.Xµ G,� <br />CONTR. LICENSE <br />nF,./.�0 6�Cr v�trrJJ1 <br />LG. <br />1 <br />'�• 0. 9,1 g i 1 3 1. M1C.Y1 ryy<Qyl, <br />No _ <br />f{d'S' $'04 -obo <br />-r�--� <br />6A t. L•y <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />�5'I d�` &,( <br />_ Electric Gas Other <br />I f! <br />9_ q In <br />WORK DESCRIPTION <br />lZe - Gyv-tuAJv\5 -}va!' of-;) <br />NO. I TYPE OF FIXTURE OR ITEM <br />I octet <br />Bathtub <br />Lavatory (wash basin) <br />_ Shower <br />Kitchen sink S disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servics/barlmopletc ) <br />_ Backtlow preventer <br />_ Urinal <br />_ Drinking Fountain <br />Floordrain <br />_ Grease trap <br />Root drains <br />Other_ <br />NO. I TYPE OF FIXTURE OR ITEM <br />AJL, - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />_ Gas range <br />Clothes dryer <br />_ Range hood <br />_ Exhaust fan <br />_ Heat pump <br />Unit heater <br />_ Boiler <br />_ Refrigoration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALCS TAX CODE 15 3100 <br />I hereby certify that I have read and examined this application and know the some 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 authorized by the owner of this property to perform the work fur which application Is made and I comply with the <br />State Contrpclors Law 18.27 RC11V and 296.200 WAC. <br />Lf-��B-lo <br />