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i <br />PERMIT 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 <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM 4 ` a '!, — O� <br />SITE ADDRESS <br />PARCEL TAX I.D. K <br />PERMIT <br />LEGA LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION R <br />DESC. <br />OWNER ADDRESS CITV2I11, PHONE <br />LUt�erqfj Cot✓,eq� FV�it# WA.YYVZI <br />//...i1' <br />TENANT NAME CONTACT FOR PERMIT PHONE of'75 3 <br />J. <br />-� 'N�1 1'f LI•i t/f e'�!{N I ���. ��.. J'r/ � /I� eI� <br />/ <br />E-MAILE-MAIL—C6RTAAi. �-C1TVT1 'PtIU ;a any =� <br />rt �.� r"eT ;� D r 3 3' hV� ry c,�,,l/!!-< , o• � 4331 P 1 <br />CONTR. LICENSE 0 ' <br />AAq �rsrt�-ins <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />_ _Electric _Gas — Other <br />WORK DESCRIPTI N./jNSGr L I� ` lUZ L{ L $•OC <br />4/5*e".) Fire Sappr�ss.oN sysf•N X-/V <br />yr" LLuN G7 ylt I�D �} q tN1" <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />NC -air handling units <br />_ <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />_ <br />Water healer <br />_ <br />Kitchen sink R disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />(service/bar/mop/eta) <br />Exhaust fan <br />_Sink <br />_ <br />Backflow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />Grease trap <br />Roof drains <br />Woodstove e <br />OtherjX �/t SN�9p!!5S/aiJ <br />Other <br />S .T Y PM /iN5 g 6 N l 3 De <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby codtify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />oMinaces 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 pm{xny to perform the work for which application is made and I comply with the <br />State Contrac ors Law 18.27 RCVS and 296.200 WAG. <br />SignaNre 0 er/ tractor Authodzad Agent ate e <br />1/ Z <br />