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Pr.RMIT 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 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />ERMIT # <br />TJ11'. ,Fv r�}°Blc; <br />00`I1�ylCcncy$r7L <br />U)j—ONCJ <br />LEGAL LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION #^7� <br />DESC. <br />-' <br />:.I,- jn:- -ro; o(1f,':' CQ♦r 1o2-zco$-Od7— <br />OWNER ADDRESS WI TRIP PHONE <br />VaA kut v. 1090 Vrlla MOn}e—Ci. aNukll�ec °I�a:l> 412—S-ot -1 LOo <br />TENANT NAME <br />CONTACT PHONE 4L$ • 34b-3` 7S7 <br />pFOR 1PERMIT <br />I Ffl�0. IAA yt'C'� �rrd��y*'(Q'fC �lt <br />.. i tlr f- <br />E-MAIL 'k- <br />-------------------ESCITY/ZIP PHONE <br />CONTRACT R <br />nADD� <br />CONTR. LICENSEp <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />X Electric x Gas Other <br />I <br />( tSo oov' <br />WORK DESCRIPTION <br />mnu 4usc' <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />S <br />Toilet %% % <br />f <br />A/C — air handling units <br />Bathtub , <br />I <br />Forced air systems <br />Lavatory (wash basin) 11 ►1 <br />1 <br />Gas piping <br />J_ <br />Showery <br />t <br />Water heater <br />Kitchen sink & disposal <br />1 <br />Gas fireplace <br />_ <br />Dishwasher <br />r <br />Gas range <br />Clothes washer <br />I <br />Clothes dryer <br />i <br />Water healor <br />I <br />Range hood <br />I <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow prevenler <br />Heat pump <br />_ <br />Urinal <br />4 <br />Unit heater <br />Drinking Fountain <br />Boiler <br />_ <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify that I have read and examined this application and know the same to be true and co;reel. All provisions of laws and <br />ordinates 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 stale or local law regulating construction ar the performance of <br />constructi hat 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 aoqlr s-Caw 18.27 RCW and 296.200 WAC. <br />/ 2i• v <br />Sig ure of O)� IConlraclor/Authorized Agent Date ) <br />/Z <br />.Corn <br />