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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />37.00 CEDAR STREET, EVERETT, WA 98201 <br />ba <br />425-257-8810 —FAX 425-257-8857 — wv✓w.everettwa.org D& - <br />(� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. I <br />60 00fk)0 00 <br />PERMIT # <br />�I�l - �3 <br />LEGAL LOT NO. <br />DESC. 1 2: 7-06 <br />BLOCK <br />TRACT <br />rWI.v �LL D!U <br />OWNER ADDRESS CI1Y21P PHONE <br />i till NOS t-C PO 264 293 EDrnoNOS q0,20 706-919-7 � <br />TENANTNAME <br />CONTACT FOR PERMIT PHONE <br />MUL KE61ZNEy 206912 �58-fo <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE d <br />USE OF BUILDING 1 HEAT SOURCE CONTRACT PRICE OF WORK <br />SFP— _Electric .�/Gas_Other <br />WORK DESCRIPTION <br />51N&LIE CA2 G1%Z46-G <br />gl)I1,.9 y50 s F-t f�D01llON - 2. BAR, 9 <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 />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 />_ <br />Dishwasher <br />Gas range <br />dryer <br />_ <br />Clothes washer <br />Water healer <br />_Clothes <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />� <br />Exhaust fan <br />_ <br />_ <br />8ack0ow prevenler <br />_Heal <br />pump <br />healer <br />Urinal <br />Drinking Fountain <br />_Unit <br />Boiler <br />Floor drain <br />_Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />_Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 0105 <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 glue authority to violate or cancel the provision of any other stale 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 Contractors Law 18.27 RCW and 296.200 WAC. <br />Signa ure of OwnerlC t clot/Authorized Agent Date � L <br />