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P�.RMIT APPLICATRA <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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />3y18 �ack e{�e Il Pr Aye UO 3� 9 8 z) c �3oG f3aso5 -ol <br />LEGAL LOT NO. BLOCK TRACT <br />OESC. <br />OWNER ADDRESS CITY/zIP PHONE Z.S2 — <br />Mpttxare4- PhL-ecd 3`II& RvdkPNIle-' 4✓q- Fvegfi Gu/]- gS261 2-g37 <br />TENANT NAME <br />CONTRACTOR <br />Occ.' n e <br />CONTR. LICENSE # <br />USE OF BUILDING <br />ya roLg e-- <br />WORK DESCRIPTION <br />Rolfd Au/'?se- <br />CONTACT FOR PERMIT PHONE <br />ADDRESS CITYIZIP PHONE <br />HEAT SOURCE I CONTRACT PKIUL Ur v umm <br />Electric _ Gas _ Other �Sd <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Toilet <br />Bathtub <br />basin) <br />_ <br />_ <br />— <br />Forced air systems <br />Gas piping <br />_ <br />_ <br />Lavatory (wash <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />— <br />_ <br />_ <br />_ <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />— <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heal pump <br />_ <br />Urinal <br />_ <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />— <br />Boiler <br />Refrigeration <br />_ <br />Floor drain <br />— <br />Woodstove <br />_ <br />Grease trap <br />_ <br />Other <br />Roof drains <br />Other. <br />— <br />CITY OF EVERETT LOCAL SALES IAA Wue a a165 <br />I 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 slate 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 Gonlractors Law 18.27 RCW and 296.200 WAC. <br />