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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.everethva.org <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT>t <br />22 W07 n11rL1-vf G,./ 2. <br />9a ! 8eo o n <br />LEGAL LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION p <br />DESC. <br />OWNER ADDRESS CITY2IP PHONE <br />�VmtF�f M"NIj- ✓i"G P- ()- �X llos (V1;4W f L,, zoo <br />NAME CONTACT FORPERMIT <br />pHVVO <br />PHONLF( <br />?�IMa2 <br />�-0 <br />/ EMAI�1 <br />./✓y^+7VgA1.Qf 7n7rf0 <br />✓5l0 <br />_TENANT <br />LD <br />CAdriNgiIs/ ADDRESS 21P NE <br />cvtip. <br />t+��// <br />' Zf� �� "L� � � <br />COtITR. LICENSE p <br />N��Su31m3 (2d6) 2S2-07170 <br />USE OF BUILDING <br />HEAT SOURCE <br />CO TRACT PRICE OF WORK <br />_Electric _Gas _Other <br />� 7/Z� c'? <br />WORK DESCRIPTION <br />(r,r)TArt <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 <br />air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />_Gas <br />piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink 8 disposal <br />_Gas <br />fireplace <br />Dishwasher <br />_Gas <br />range <br />_ <br />Clothes washer <br />_Clothes <br />dryer <br />_ <br />Water heater <br />_Range <br />hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backllow preventer <br />_Heat <br />pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />_Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />Roof drains <br />_Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br />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 tlli 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 viol ,e o cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I a aut rued by the owner of this properly to perform the work for which application is made and I comply with the <br />State Contractors La and 296.200 WAC. <br />V117—Z�-U <br />Signature of Owner/ ntr r/Authorized Agent Date <br />