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F .AM!IT APPLICATIkA <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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />q'30 <br />PARCEL TAX I.D. # <br />PERMIT # <br />-�7 <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />CJI: , 4 (,- ,f(�it,, t �" A—'W9C( <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />I <br />C41 o� ti*,iefi <br />51,89 b <br />Sc4 "16o \ <br />CONTRACTOR Wl� n-`l v( �toon�� ADDRESS CITY/zIP PHONE <br />W(T r'Y7 <br />9000100CJkt%U'((r-sv�.a(J- <br />CONTR.LICENSE# WA(30Ti. *6gq�N PC) r>oy kaoc q"st 7a <br />USE OF BUILDING <br />HEAT-JOURCE ft(C o0 k,-j <br />CONTRACT PRICE OF WORK <br />i�l CE <br />___� Electric _Gas—( <br />I <br />01 6 u O) <br />L <br />WORK DESCRIPTION t (1S Tf -�- (\e_UJ % V DL I /� JC u A l r Fze, R- 5 t Y 111 <br />FLOO(Z eCAAPU7U—k ELQuipt4 G[ l j- PG(0. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />,A_ <br />A/C - air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water healer <br />_ <br />Kit�...n sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />_ <br />Range hood <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 0105 <br />1 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 />ordinaces 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 author' y to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction hat I am authorized by the owner of this property to perform the work for which appacation is made and I comply with the <br />,.Stete-Co ors Law 18.27 RCW and 296.200 WAC. <br />Sig1imture Owner/ ontractor/Authorized Agent Uate <br />