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APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 —FAX 425-257-8857 — vdww.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO PM a —aS -Oj3 <br />SITE ADDRESS <br />2630 rard Avenue. <br />PARCEL TAX I.D. # <br />PERMIT # <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />iOZ <br />a\lQen. M. Lr2nf101n� 21n30Glan6( iii Eyere* qm1-3.9?4 -%s--r <br />TENANT NAME CONTACT FOR PERMIT PHONE �a�l <br />Ian. M. l�tn��atss �i as- as-s-3a� I <br />E•MAIL <br />CONTRACTOR ADD S CITYIZIP PHONE <br />1�0.�es �� ���3(033 qz <br />�nrlq PYls.e EVeve(� q8 ae3 <br />-4 l�iw iS <br />CONTR. LICENSE p <br />USE OF BUILDING � HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />_Electric _Gas _ other <br />WORK DESCRIPTION Q'Y(2) <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />AIC -air handling units <br />_ <br />6allilub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />Kitchen sink &disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow prevenler <br />Heal pump <br />Urinal <br />Unit healer <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVEPETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined this application and know the sar ie to be true and correct. All provisions of laws and <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 authority to violate or cannel 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 properly to perform the work for which application is made and I comply with the <br />Stale Contractors Law 1'f)1/2)7 RCW and g(i.20/0 WAC. I <br />/ <br />Signature of OwneriConlractorlAulhorize Agent Date <br />PERMIT <br />