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ra <br />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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />P�gMIT # <br />2 <br />31131 N A S71- <br />_ <br />LEGAL LOT NO. BLOCK <br />TRACT <br />DESC. <br />CI <br />OWNER ADDRESS NRIP PHONE <br />CC,, P aflaXrIC-S 140E-7 j404r 14yv' sr foy EVFrerff- '/l- WN f3l�PS£3 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />/JAS&4;* P0.1—rOICA aVILIY@A <br />p <br />-2C20MV sl-tA j Lin. (Doz- <br />CONTRACTOR ty\C-l2tT'MftA4AAjIi ADDRESS 47((o'30 . IS'%" CITYIZIP PHONELMS-8$3-C}ZL`I <br />Q':F <br />CONTR. LICENSE Nk ItITN\X 1Lii — <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />C,LI 0 LC.- <br />_ Electric X Gas _ Other <br />ee eys3s 1 <br />WORK DESCRIPTION (e- RODF-T=IP 0 N ICI &KM*L;4-o F*I4t . 2- 1XIIIIIII-W iF t4iii <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C - air handling units <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />, 3F <br />Range hood <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />_ <br />Unit heater <br />Drinking Fountain <br />_ <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodstove <br />_ <br />_ <br />Roof drains <br />_ <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br />I hereby ceritify that I have read and examined this application and know the same t0 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 />State Contractors Law 18.27 RC 296.200 WAC. <br />S-L-oS <br />ure of Owner/Contractor uthonzed Agent Date �� <br />