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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />42b-257-8810 —FAX 425-257-8857 — vrww.everetlwa.Drg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT <br />18 I Vir i1n�(� .f, <br />0oN3 N3eo015o0 <br />LEGA LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION# <br />OESC. <br />y <br />OWNER ADDRESS CITY2IP PHONE <br />�CcSo N ✓ i vti;yt i a f}.,,e {y. pJL�f4 9 d ,o l Zrx. 8s z Y3 b <br />TENANT NAME CONTAC OR PERMIT PHONE <br />f <br />� -Zo u 5`?5-71a�3L� <br />IleA_ <br />6(A, E-MAIL <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />QSAU� Pof 'K�.0 w�ri USZolo 999 7 <br />CONTR. LICENSE /5i,114CIZCgI1—I,—(LU1J�'o7d7K/,-I/kedyulfgC56SZ(0103 <br /># <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />` <br />_Electric _Gas _ Other <br />J <br />WORK DESCRIPTION <br />1,1,1o L C tihDt ✓L? IAGQ l�o� Nj.•, <br />((// <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 />Lavatory (wash basin) <br />_Gas <br />piping <br />_ <br />Shower <br />_Water <br />heater <br />_ <br />Kitchen sink &disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />_Gas <br />range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_Exhaust <br />fan <br />_ <br />Backflow preventer <br />_Heat <br />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 />_ <br />Roof drains <br />_Other <br />Other <br />CITY Of EVERETT LOCAL SALES TAX CODE IS 3105 <br />hereby ceritily 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 this typo 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 few regulating construction or the performance of <br />hat I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />construction. Tt�k <br />State Law 16C.27•RC�W^nd 296-200 WAC. <br />��Conlr��ors <br />et <br />Signs re of Owner/Contractor/Authonzed Agent ate <br />