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5 <br />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 ARESS <br />117 2 V/Or Im0f/f ✓ifr/ pt• <br />PARCEL TAX I.D. # <br />%V116 011 y <br />PERMq # S <br />S 3 0/ <br />LEGA LOT NO. BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />C. ✓&V7y rn*jjr� ✓11444Y P U. d ox lip? 0rm"I"..f MAI( <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE 2ti 0-5Z -0 reo <br />R(Mj4h4Ir 6a1�� <br />I Sif✓E ZrlMtd ir✓ EMAIL +Y✓cz� I <br />,1 / i21 <br />CONTRACTOR` PlAx CC� �ZJrrxs7'N,4�At�r,✓. Saµ� 9a/c! (7a6� zYzar�� <br />CONTR. LICENSE# n%b'113ei J��2 <br />USE Of BUILDING �jI r.,�._,/ <br />HEAT SOURCE <br />CONTRACTPRICE QF WORK <br />— Electric _Gas Other <br />WORK DESCRIPTION <br />�NILp/✓6 SIGN] (9164WO FinJ P9,C <br />�nlj /sfc 2 �6✓ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C - airhandlingunits <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />_ <br />Water heater <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water healer <br />_ <br />Range hood <br />Sink (service/bar,!mop/etc.) <br />_ <br />Exhaust fan <br />Backflow preventer <br />_ <br />Heal pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />__ <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 />ordinates governing4hin type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give aulhonly to iolat or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. Thar: am uthorized by the owner of this properly to perform the work for which application is made and I comply with the <br />State Contractor Law 8.27 RCW and 296.200 WAC. <br />Signature of Ow /C nlractor/Authorized Agent Date <br />y� <br />