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I-CRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - tU`vw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO A PM <br />SITE ADDRESS <br />PARCEL TL % I.D. # <br />PERMIT p <br />I -D/��l2 -CYO <br />yyoa S. 3M) RUB <br />0 oaHW: Doi oc) <br />LEGA LOT NO. BLOCK TRACT <br />t� �t <br />DEsc. > a pp(o LOWED-:.. �/ � V <br />OWNER ADDRESS CITY/ZIP PHONE <br />.iUK Pads, LI-C- loyal urrtf JoHN cr EQ�IW@s qWo 200A <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />PAvL KEr42Un zoo 9197584D <br />` <br />CONTRACTOR DW��IVVGG ,^(�`�vjLO� ADDRESS CITYIZIP PHOPHONECONTR. <br />LICENSE g <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />//1 <br />tTrf(ZA&E�1SNM <br />'Electric _Gas _Other <br />I <br />WORK DESCRIPTION <br />DEmu.mON of sin>GL.E CAR o6-1-�}cNcfl C-0-r4GE 4 SNED <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 />Lavatory (wash basin) <br />_Gas <br />piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />_Gas <br />fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />_Clothes <br />dryer <br />_ <br />Water healer <br />_Range <br />hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backllow preventer <br />_Heat <br />pump <br />_ <br />Urinal <br />_Unit <br />healer <br />Drinking Fountain <br />_Boiler <br />_ <br />Floor drain <br />_Refrigeration <br />_ <br />Grease trap <br />Woodslove <br />_ <br />Roof drains <br />_Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <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 state or local law regulating construction or the perionnance 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 />Stale Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature OerractorlAuthonzed Agent Date <br />