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t <br />PERMIT APPLICAT;ON <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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />rr <br />,.2/' (,TA ^ KES Vr' CVULIC'77 <br />/�G4�i•%"GQ�-- <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYZP PHONE <br />/ //�� <br />11L%YZ? ClcntIT YWL)l QW70-IS8-3068 <br />/•1Sy <br />Vt. V �A(ELiud A e 5 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Cyas).�s8•s esrY <br />f <br />SA y6 <br />C, LIL14 LYE' 45Jis -61%3 <br />_ <br />CONTRACTOR r jUNN M-ty ADDRESS CITY2IP PHONE_ 3a)r�SS-6/ <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORN <br />Electric X Gas _ _ Other <br />WORKDESCRIPTION 1jYiA A S/mPLE 94r}/F c1c,f Atv 7NF 9R E,*jE47, <br />J PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />NO. <br />TYPE OF FIXTUPOR ITEM <br />Toilet <br />A/C - air hLndling units <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Showr.r <br />Water healer <br />_ <br />Kit itm sinK & disposal <br />Gas fireplace <br />D ,hwasher <br />Gas range <br />_ <br />Ifi <br />Clothes was ter <br />Laundry tral <br />Clothes dryer <br />Range hood <br />Sink (servic /bar/mop/etc.) <br />_ <br />Exhaust tan <br />_ <br />Backfi�rrw pn venter <br />_ <br />Heat pump <br />Urinal <br />_ <br />Unit heater <br />_ <br />_ <br />Drinking!"oLidain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />WoDdstove <br />Roof drains <br />Other <br />_ <br />Other cj3^,,,-2z rs •.` <br />CITY OF EVERETT LOCAL SALES TAA CODE IS 3105 <br />I hereby centify that I have read and c xamined 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 perfeml the work for which application is made and I comply with the <br />State Contractors 18.27.RCW and 296.200 WAC. <br />�Low <br />tsignature Ovmef/Contra or/ uthonzed Agent Date <br />