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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 f •'E ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PPRMIT # <br />6d3 Mduaa/5jycltvUG- <br />Go3ftW3006906 <br />Q -/ <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. FSI Of, I U d <br />1,31 <br />3 I <br />Ca rLA-ti'o v/GrG✓ .fob <br />OWNER ADDRESS CITYIZIP PHONE <br />/fir Kites 'rd j�o ok3 /,g,* 6y�ltXCEi,�nt7 Ftt4o/ <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE `rL r L Srf 9 f P, 3 <br />PH iA. root-; <br />E-MAILCI~4Ak <br />CONTRACTOR ADDRESSCITY/ZIP PH <br />0v1,rJG <br />CONTR. LICENSE # �j f j.U/ ;- <br />u nine/ i_ r 0 r! 4%1 L <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />/4e S//)C- Ale G <br />— Electric X Gas Other <br />.D 'yr' 6a), <br />I <br />WORKDESCRIPTION K/1t�lfEiv keep%0 6r6 ,'r_,vIWC eK.Sfih7 Cz;_6,iLelzy iI'LIr'*-// 7dJo <br />crxGiihrfS cr.r� :s/aMr� .NaiK sihl� lL is/wcP e)c <br />fl.ar <br />I%)f>i •�fc >a c,K�r ��+- .�'' .'-/-/'/,�-.rs.,- �c%ti��� w.z.� <br />'.0t sFti7 7�� �'rc�l� e <br />re <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR 11 EM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />_ <br />A/C - air handling units <br />Forced air systems <br />_Bathtub <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />Kitchen sink & disposal <br />I <br />Gas fireplace <br />_0 <br />Dishwasher <br />I_ <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water healer <br />i <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />I <br />Exhaust fan <br />_ <br />BackBow prevenler <br />Heat pump <br />_ <br />Urinal <br />Unit healer <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease 'ap <br />Woodstove <br />_J_ <br />Roof drains / r — <br />OlharjALvjCr JiNC ir) relv�fGA7°r <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 />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. That I am authorized by the nvner of this property to perform the work for which application is made and I comply with file <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of Owner Contracto Aul orized Agent Dale <br />12 <br />