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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8657 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM S AM TO PM 7 --9L6 <br />SITE ADD SS <br />PARCEL TAX I.D. N <br />PERMIT IF(41e> <br />R.,��� AOF, <br />salt �Is��� a��z <br />�c oGc� <br />LEGAL LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION <br />DESC <br />WINN ADDRESS CITY LIP PHONE <br />CR.,ck-ev- AvE- &-tSCii- <br />TEN, TNAME <br />C <br />CONTACT FOR PERMIT PHONE 3lo-YZ4-r329- <br />�i <br />e010`1 <br />e-'Ll `cam EMAIL (0.11(' w AJ-S' Nt <br />eaRncAaTa�—f�ereiSr .f �c ;s �6oe, Nw 99 5,,, Lt-t3 2�- <br />Y -+3�. <br />yz <br />CONTR. LICENSE 1 <br />M e,ry-I- S Ao 3g Q aEyNoU..� i ..� isti,�Lu'?8273 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />--X'L � ti <br />I <br />— Electric Gas Other <br />� 4��d <br />I <br />WORK DESCRIPTION <br />3 Ccssu� SrzkS c._rl SrSwS oy PUwpS, <br />L't5�.11 <br />PLUMBING <br />MECHANICAL <br />NO, TYPE OF FIXTURE OR ITEM <br />NO. TYPE of FIXTURE OR ITEM <br />_ <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_, <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />Water heater <br />Kitchen sink 6 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Water heeler <br />Range hood <br />Sink (servico/bar/mop/etc) <br />Exhaust fan <br />BackOow pieventer <br />Heat pump <br />Unnal <br />Uni: heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Wcodstove <br />Rooldrains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 0106 <br />1 hereby o110fy that I have rend and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinances 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 performance of <br />construction That I am authorized by Iho owner of this property to perform the work for which application is made and I comply with the <br />Slate Contractors Law 10 27 RCW and 290 200 WAC <br />(3a-1-1,`'!gz,' -7-12- t o <br />Ipnoture er entractorl ul onz gent Date <br />I/ Z <br />