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i <br />PERMIT 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 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT N <br />� l 2a k�1z�� � <br />r�123 000�a2co <br />I �V l �c - CZ�v <br />LEGAL LOT NO. <br />DESC. 2, 3, 4 <br />BLOCK <br />1z 4 <br />TRACT OR SUBDIVISION N <br />N W 114- 5C4.12'f ZS -W. INWyr1 L-p RK- <br />OWNER ADDRESS CITYIZIP PHONE <br />FtJ ol �l-lgl M4 ota* Vmf 2� crl�gs�a rs��, P� �. <br />TENANT <br />FOR PPE,R.M'ITT PHONE(AjS) 8'_.2,1-j- 2,1 <br />jNAME <br />, <br />r /'1 /�1t< <br />-fLCONTACT <br />,- <br />✓YLN�sg `� C�9� 1 E�AAIL ��^F-�i 1 &HoAFelf• <br />CONTRACTOR jMS TT'�L7jr�Y.1ADDRESS CI1Y1ZIP $975 WIUawS1zD. 1 ifitmoD,L✓4 (M5�883-o4^�I <br />CONTR. LICENSE N%r�t7� 1%/G�I �1.P3iJSZ <br />USE OF BUILDING HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />my-v'f, ��j�/GjrO(�fU6 jElectric Gas Other <br />71 pOO• GO <br />_ _ <br />WORK DESCRIPTION <br />GaJ-Y�ir,uVn&I-) c"VJ Wa-Lt r?, j-00r, F'VAA-+Wuhfj-'jrl�r¢, Aoup fPVaAtr L4f-T: If *F6 w►w <br />K & 50t W VV! uMM-1110?-J Tb -tfIV- "7L0A-15' 0JD XMc F Gri-) U6U6L 1 ru �4 wUt 1 s <br />Pew I hFf Y' IZiP�N�eNC ca�hi�r ur�� 7'5'rs�c+,5. {1t>w Nvill.V%04L,6ut otm• UTWOL P+HP• <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 />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gasrange <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />_ <br />Water healer <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preven,er <br />_ <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />_ <br />Refrigerat;on <br />_ <br />Grease trap <br />Woodslove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritity 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 />Slate Contractors Law 18.27 RCW and 296.200 WAC. <br />igna re of wner/Co. raclor/Authorized Agent f Date D <br />SO <br />