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f <br />PE. MIT APPLICATIOv, <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 />I <br />� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />v`� <br />PERMIT # <br />10_Zo %!Dry �u�k 1);Z' <br />00 ll&z(1 �soo OqS! <br />If <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC.� <br />OWNER ADDRESS CITY/ZIP PHONE <br />34i M4<ON (�IZ.-3/A5T. VVtlr-W 77 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR VAtj /T'^^`` S6C• fNC. ADDRESS ClTy21P PHONE 4ZS 0%0 9y <br />_P6 <br />G <br />Q� 130" t"t,,,r,�. / 5 zv� <br />CONTR. LICENSE # 141C 30i '�So► <br />USE OF BUILDING <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_Electric Gas _Other IL DOp <br />WORK DESCRIPTION <br />K-C'- VJ-o kI` 1 aG �,.,. gc�A� t <br />i <br />PLUMBING <br />MECHANICAL <br />NO. I TYPE- OF FIXTURE OR ITEM <br />NO. I TYPE OF FIXTURE OR ITEM <br />I <br />Z <br />Toilet <br />A/C —air handling units <br />Bathtub <br />1 <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />—L <br />Z <br />Kitchen sink & disposal <br />Gas fireplace <br />_(_ <br />Dishwasher <br />�_ <br />Gas range <br />I <br />Clothes washer <br />I <br />Clothes dryer <br />—I <br />Laundry tray <br />�_ <br />Range hood <br />I <br />Sink (service/barimop/etc.) O� <br />C <br />9Exhaust <br />fan <br />Heat <br />Backflow preventer , <br />_ <br />pump <br />Urinal <br />I <br />Unit heater <br />, <br />Drinking Fountain `I <br />Boiler <br />Floor drain <br />Refrigeration <br />i <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other_ <br />_ <br />I <br />Other <br />I <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 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 Co ors Law 1 27 R and 296.200 WAC. <br />Sig ature of Owne � ontrac o Authorized Agent Lat l/� <br />