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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. K <br />PERMIT K <br />a%oa wetmairs /44c, <br />0043gII,1,70;II0000 <br />% IOl O-0 Z- <br />LEGA LOT NO. <br />DESC. AI - il{p <br />BLOCK <br />bi 7 P-00 <br />TRACT OR SUBDIVISION 11 <br />Sec 4 4q TIYP AR Rua 5 atR SE <br />OWNER ADDRESS CITYIZIP PHONE <br />Trihi+3 L1a41hxxa.n CoI►e a 4= UYV% re ANC Evue0 #&Aq 4R5-Ay+. <br />TENANT NAME <br />I CONTACT FOR PERMIT PHONE <br />4?9 bqq ;k <br />Trivi1 Lt,iµora„ Colkga <br />Mny Beaudoir, E AILamyowts+sea4+km <br />U6MA eOW1111 �y <br />11iQSi Seai4�e Nait�vnl Evttu9y,Lu 6�AI'�lMkEW 1$aai+k 98/Ab �, �.45R 8Ny� <br />CONTR. LICENSE N 1 e3TS3N°Ia, M4 <br />USE OF BUILDING I <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />U(ky, I <br />_ Electric .—Gas —Other <br />$ ►gr wND <br />WORK DESCRIPTION <br />Minch S�fteel arwmiY15 �loLl ie- is -lop Poor k pa WYq garr se_ . Fin K will QALFPOr-+ <br />Solon- V4 FdVIC S, SAW 44A Ill wal l to Uec_jrlcal pahel on n"+- door caret,'. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ _ <br />A/C - air handling units <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />_ <br />Water heater <br />Kitchen sir.K 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Water heater <br />_ _ <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />Urinal <br />_ <br />_ <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />Roof drains <br />Other__ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read 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 vio, rte 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 16.27 RCW and 296.200 WAG. <br />QA� bQ rid Ib- Is-lo <br />Signature of OV r/Contractor/Authonzed Agent Date <br />#A1A <br />0n <br />