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PLRMR AiPLICATWN <br />�RMIT APPLICATItrN <br />CITY OF EVERETT PERMIT SERVICES <br />CITY OF EVERETT PERMIT <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 />p <br />GV(oob Z0oo0' tint <br />c, ' <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. � <br />f Li <br />Do0 (7•-c( <br />I <br />�1n <br />VIES R-t04t- RvD fJY il, Z <br />- <br />OWNER ADDRESS CITY2IP PHONE �-( <br />i u5/7 � i3Zle KLI�tcF-/L fi-� �,✓ ?o I z-S z <br />v�Aq <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR Ppv %� l/E Lv/'i+�hJ' ADDRESS � CITYQIP PHON3 LtZS <br />�. o. !sir 175?L .��✓ � 3 -/Ky� <br />CONTR. LICENSE M <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />�G S_Electric <br />/� Gas _Other <br />�/ � `� <br />re. <br />WORK DESCRIPTION <br />R�j[.p/.r'AUu'b2{? c7t= ItiF>"EGv%Z / PAILTrzit�Lt/ <.�no/�� t'TC�7 /jY <br />CI��F-.1x'JFC..- <br />1 `�/i✓,c�Ilj'� �iw N.t�— �!` (lltf.4 /�ff�lL.I'H ITS <br />! / <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />I_ <br />Toilet <br />A/C —air handling units <br />I_ <br />Bathtub <br />I � <br />Forced air systems <br />I, <br />Lavatory (wash basin) <br />'—� <br />Gas piping (� <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace n <br />� <br />Dishwasher <br />Gas range UD <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />_Clothes <br />r � <br />'L_ r� <br />dryer <br />Range hood <br />Exhaust fan <br />_ <br />Backflow preventer <br />Urinal <br />Heat pump b ,1 <br />Unit heater r <br />_ <br />Drinking Fountain <br />Bailer V <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove IV <br />_ <br />Roof drains <br />Other <br />Other _ <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 />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 taw regulating construction or the performance of <br />M..W <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 />t `�5 <br />Stale Cont Law 1 RCW and 296.200 WAC. <br />Signature of O er ontractor Authorized AgenT� Date <br />