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F `RMIT APPLICATIUN <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 PARCEL TAX I.D. # PERMIT # <br />n <br />\bI-) <br />0' <br />RV, (2 LC-) E> - 4 --7 <br />LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION # <br />DESC. �ARBC���%� <br />OWNER ADDRESS CITY/ZIP PH �El/�5,���_ <br />/n30 N, f'ikR� �� ��rY8).e3 <br />lif'�l�o�i�y� �' <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />A <br />/ �' / <br />1 E-MAIL <br />C NTRACTOR ADDRESS CITYIZIP PHONE <br />OAS A�tSov Cvsio k Ner1«s %Nc, /OS:4/ ,V,('*Rr\,DR_ <br />_ <br />CONTR. LICENSE # 9 C : 0 3 �1 ;7- S <br />USE OF BUILDING <br />HEAT SOURCE I rDCN�TRACT PRICE OF WORK <br />v <br />" ' f O k" 14 t_ , � � v� <br />l ��)y r <br />_Electric _Gas _Other I / <br />WORK DESCRIPTION <br />D V 41- (_ O F- G:_:A \ S i f G 6A V2 11- G 9- %F N P L I�- C-'F— VV"- rJ T <br />,fR, <br />19 c= f� k�_:Lv :3 C,AQ_ G <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR IT'M <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — airhandlingunits <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />Water h ater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backffo.v prevenler <br />_ <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrige7ation <br />_ <br />Grease trap <br />Woodstove <br />_ <br />_ <br />Roof drains <br />Other _ <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I Have read and examined this application and know the same 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 cancel the provision of any other state or local law regulating construction or the performance of <br />cons' clion. That I am aulllorized by the owner of this property to pe form the work for which application is made and I comply with the <br />lraclorsL w 18.27 RQyV/� 2AC. <br />Sfat on17 <br />Si nature of Owner/ConlraclodAuthonzed Agent Date �/ <br />L <br />