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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 <br />SITE ADDRESS <br />/30 1)1410 cZA D 2k�e- <br />PARCEL TAX I.D. # <br />00,go 7 DO-1500700 <br />PERMIT # - <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />EvGzG� <br />rf'A Of3��5�) 11'7A04r /312 (1tar4'«,Jn ,41ti 9k�3 1rzsas-«w <br />TENANT NAME <br />CONTACT F OR PERMIT /� PHONE <br />Br�T'7 <br />E-MAIL <br />CONTRACTOR ADDRES. IZ P PH 'NE <br />IM PLM6 rc-,Mj(r 14&lq 13-tk A-4,Y-0- GI/rVN, 4(2-5175 (vq&t <br />CONTRAIL NSE <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />A <br />I <br />9, � 70.00 <br />— Electric Gas —Other <br />WORK DESCRIPTION lQCPLgCe Ex)sT7,JF 6A5 SOLOC- WiTN Neal 6�1`'s <br />&N-6e ZrI 547701-if, LOCAf76)rV 471D jlS7-*/- 4- lt'�w � <br />90ILG2n1R7Z5 HV I- U/ATVIIL 414147p P-EPCACE rHE <br />c0e4-T-101-J, <br />,rxf577N l- .7W rwe S grnE <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 />Shower <br />= <br />Water heater <br />_ <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />_ <br />Urinal <br />Drinking Fountain <br />= <br />Unit heater <br />Boiler <br />drain <br />Refrigeration <br />_Floor <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 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 Contr cloys Law 18.27 CW and 20 WAC. <br />GJ/ 1-30-6r <br />Signature of ner/Contractor/Au riz d Agent Dale <br />