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PERiviIT 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 B AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />5o i vt <br />oolo-0000 <br />!_ <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />�Ckc�Y1Q,l� <br />�Zllt1 zirnrinr r rvlottl, Igtnli I i 5�t I I SQua �I �icl�ae (tlyele- cmjL 3 / �o�i1993- IS54 <br />TENANT NAME �— CONTACT FOR PER PHON9 x ( R0 <br />�yj sl r C- P�xyJutir astr�� 600 (t(�c��c , Ct0t1Wl/�k�lll bg-e5)o6-Iort !e <br />CONTRACTOR ° --�—� AS CITYIZIP JPHOkE <br />TOE <br />CONTR. LICENSE M <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />IiVq(- <br />Y S <br />_ Electric _ Gas _ Other <br />�I t Doo <br />WORKDESCROTION �r yKhb It�� tG/CIMt �} 1 <br />IIrfitt\cK Reh��fiS �v Incl�tcle_ YleiL� �avtl+yut� Malls C{oovs, Yell�eS <br />kvY VAC W %Sr, rlc V-Myv) . <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (servicelbar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <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 />1 hereby ceritily 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 Co ,,tors Law 18.27 RCW and 296.200 WAC. <br />., 19 -o ,,- <br />w r Contr 'ctor/Authorized Agent Date 1 <br />Signature of Owl <br />L <br />