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APPLILATIO <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.ag <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 1 PM <br />SITE ADDRESS <br />2-ao 4 r D v�vc� <br />LEGA LOT NO. BLOCK <br />oesc. 2 � <br />OWNER <br />�-a'� A ��t ���t � f <br />TENANTNAME <br />PARCEL TAX I.D. � <br />eo <br />TRACT <br />CONTACT FOR PERMIT <br />A�► <br />�vtrFf�,tM <br />i �--1 D "p % <br />�Lr �4�Z �Koa <br />PHONE <br />M�Ke�I�, I �.o�sRnl� ��R�i�� �-Zs �-�.z �soo — <br />CONTRACTOR ADDRESS CITV2IP PNONE <br />CONTR. UCENSE K O W I�'�/1/ <br />USE OF BUILDING <br />� <br />WORK DESCRIPTION <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shawer <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/barlmop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />HEATSOURCE <br />Electric Gas Olher <br />NO. <br />CONTRACT PRICE OF WORK <br />— -� – <br />so-�a, � i <br />MECHANICAL <br />i'YPE OF FUI7URE OR ITEM <br />A/C – air handling unils <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas ranpe <br />Clothes dryer <br />Range haod <br />Exhaustf2n <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAl( CODE IS �105 <br />I hereby ceritiry that I have read and examined this application and know the same to be true and cortect. All provisions of laws and <br />ordinaces goveming this type of work will be com�+lied with whether specified herein or not. The granting of a pertnit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating constructlon or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which applicedon is made and I comply with the <br />State Contractors Law 1B.27 RCW and 296.200 WAC. <br />Signature of Owner/ContractorlAulhorized Agent Date �/ <br />�Z <br />