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APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 -FAX 425-257-8857 - www.everettwa.org �O6o� _�/10 <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />SITE ADDRESS r7 v-C.�)'f l � 2-� I <br />PARCEL TAX I.D. k <br />L�RMIT R <br />yF 3r—Ru�6e�— <br />LEGAL LOT NO, BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY2IP PHONE <br />/4i � � -/� r. y'- r 0j/9 S'g 2 n l 339 - %YacJ <br />TENANT NAME <br />I CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS 6,--7 CITY/ZIP PHONE S2UC <br />1 / / 7 <br />JZ <br />CONTR. LICENSE If <br />✓D 2�7 _- / Y�t.J/�U'e ((J � Z �� I-UC'. 1��yC C,/G' Z() (� <br />/7'LLY- R /' � ! / L'/ <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE O/ F WORK <br />LC_Electric <br />_Gas _Other <br />� -7 5' O L Ut� <br />WORK DESCRIPTION <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 air systems <br />_ <br />Lavatory (wash basin) <br />_Gas <br />piping <br />Shower <br />Water heater <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_L <br />Dishwasher <br />Gas range <br />.2- <br />Clothes washer <br />Clothes dryer <br />� <br />Water boater <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />_ <br />BackBow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit healer <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />_Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 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 18.2 ,RCW and 298.200 WAC. <br />/'`.2 �`' '? - /Y-G <br />PERMIT <br />M <br />