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UJI <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 8 AM TO 4 PM _ q-0 <br />SITE ADDRESS 2 01P L uJ -d w o. c A" <br />`i <br />PARCEL TAX I.D. N <br />PERMIT <br />- GD <br />t-)'l g Zo I <br />1 - �L, 1-o11 - 0000 <br />LEGAL LOT NO. BLOCK <br />oEsc. I- S c �I -Z1M 1 b� <br />IIlI-� <br />TRACT L �-t7^�A'�n COIQ p1 <br />0'-r c: x Q- 1✓ I K1 0 <br />OWNER I ADDRESS CITY/ZIP PHONE <br />-1k-Ir1ltzt LU+L':'C.r, C-)Kk �.3<,L we6'0d.t lay, E��,�� N <br />w gxa01 <br />TENANT NAME <br />0.r\c�i�e�.� <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />MwcU6r�o�\a Ih�l\ev -171-) 3)(fiali- (�Axj Sly <br />CONTR. LICENSE M <br />N1ACOo�S F0o ZU )Zl3lloy D <br />USE BUILDING <br />HEAT SOURCE <br />ONTRACT PRICE OF WORK <br />/OF <br />A <br />(1 11-) rl-. Q f" ' 12 � <br />( <br />Electric Gas _ Other <br />d1 j ` O . (Do <br />WORK DESCRIPTION <br />Ad& \ S )r} s�S+em A-fC Unf4 wtif�, 200- Elf` C0�v�dens/nL4 r`i� <br />9 <br />'i <br />vc <br />�}o Ni(1r(9r SIGtP <br />CO/Li4. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />et <br />/ <br />AIC — air handling units <br />_V <br />Forced air systems <br />_htub <br />_atory <br />(wa basin) <br />Gas piping <br />_ <br />Water heater <br />_wer <br />_hen <br />sink 8 disp I <br />_ <br />Gas fireplace <br />Gas range <br />_hwasher <br />washer <br />Clothes dryer <br />_thes <br />tray <br />Range hood <br />_ndry <br />(service rlmop/etc.) <br />Exhaust fan <br />_k <br />venter <br />Heal pump <br />_kffow <br />al <br />Unit heater <br />mg Fountain <br />Boiler <br />r drain <br />Refrigeration <br />ase trap <br />Woodstove <br />f drains <br />Other <br />er <br />C ITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby centify 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 rtomplied 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 />cons ction. That 1 am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />ale Con ractors Law 18.27 RC 96.200 _WAG. <br />1 c <br />Sign ure of erl ontractor/Aul nze Agent Date <br />-- A(L\A <br />