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PERMIT APPLICATION <br />CI i Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - mm.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />^I n-uLs6 ' L tie- <br />GGS S'&:-(:�I33DI7eO <br />(ry <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />STan�E�lP��-� 6la M 4C(LSBy Ln: q C! tizs-z�8-�i�8 <br />_7ij6'17)45: <br />TENANT NAME <br />CONTACT FOR Met PHONE <br />`105775-elleel <br />�P4'4r�1 ��� <br />E-MAIL <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />PM e-n-'r,E /& I/ W/J. ,�25-775-(��l(o!I <br />CONTR. LICENSE # <br />DA y'.t' rlpH 9z4q IQ4' i 37 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACTOF WORK <br />g <br />_ Electric XGas _Other <br />'P/RICE <br />3,1/8y <br />WORK DESCRIPTION <br />REPLRGE z�xf�5i7�%L4- 674-5 Fc;eNA�E>� t+ n,i��.v 6y1s <br />PLUMBING <br />MECHAN!Cj L <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIX": URE OR rrEM <br />Toilet <br />A/C — air handling units <br />_ <br />_ <br />Bathtub <br />T <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water healer <br />_ <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Bailer <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roc;a ins <br />Other <br />Other <br />CITY OF EVERETT LOCF l- 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 />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 state or local law regulating construction or the performance of <br />construction. Thvt I am authorized by the, owner of this property to perform the work for which application is made and I comply with the <br />Slate C ctors Law 18. CW and 2 .200 WAC. <br />Signa Gre Owner/Contractor/A , o ale <br />