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APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 -FAX 425-257-8857 - tmvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. R <br />� RMR A <br />-� � <br />q$oq OLYIAPIG. fjLvn, <br />Do�iLD�lOeeo creel <br />%��� <br />LEGA LOT NO. BLOCK TRACT <br />DES SE6 4T, A I <br />OWNER CITY/aP PHONE <br />,A/IDDRESS <br />Ret£a? d' Rhiel�yA tfE,E,u T3f9 OLY�P/G. Rwo. EV✓gm l32ni iiLS,z5y,9zv1 <br />TENANT NAME CONTACT FOR PERM'R PHONE <br />fJ^ I RoREu.T 1z,EEv 'iL5-.5q9,70/l0 <br />CONTRACTOR ADDRESS CITY/DP PHONE <br />7'p RE SCLEc.7Fy <br />CONTR. LICENSE f <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />ALLE4%nq.Y fo Sf�••CpdR+f4f. 7` <br />r$b,osa <br />4.r1E offrLt <br />i�Electric _Gas _Other <br />L`ST, <br />WORK DESCRIPTION <br />7JEW Woop FanrdE DETraG►:`LG rjAR„d� YJ�IiMdL afF/� A6fvE <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 />_ <br />Bathtub <br />Forced air systems <br />1 <br />Lavatory (wash basin) <br />Gas piping <br />I <br />Shower <br />I <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Disl.washer <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (servicelbarlmop/etc.) <br />2 . <br />Exhaust fan <br />_ <br />Badctlow preventer <br />Heat pump <br />Urinal <br />Unit hexer <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 7706 <br />I hereby cerihty that 1 have mad 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 W perform the work for which application is maAe and I comply with the <br />State Contactors Law 7 RCW and 296200 WAC. <br />ZS.o"1 <br />Sign u�r� of�Owne Co adorlAuthonzed Agent Date <br />lli <br />PERMIT <br />