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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - =AX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />SITE ADDRESS <br />I rG Ad LOT NO. I BLOCK 1 <br />C�t61��N:r�;� aii>�ilzesl ZZc-2 <br />TENANT NAME <br />PARCEL TAX I.D. If,:�� <br />OR SUBDIVISION # <br />CONTACT <br />TFFOR <br />QPERMIT PHONE <br />D/i/ rr (Il lkekfzz� E-MAIL <br />GUN I HAG l vn <br />�Z`E9 %/o",4!�t; /ZY1z <br />CONTR. LICENSE # <br />USE OF BUILDING S� <br />fi/k/���III `'�C� <br />EyIIPsi <br />WORK DESCRIPTION <br />r <br />I'leIw <br />Sr�IF��:sus' <br />HEATSOURCE <br />Electric / Gas —Other <br />1910 -�6l - 4 / <br />PERMIT # <br />PHONE <br />rises <br />CONTRA01 NHIGt Or "vnn <br />f%' j onfi <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />AC — air handling units <br />�Toilet <br />4 <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />T <br />Gas piping <br />�T <br />Shower <br />Kitchen sink 8 disposal <br />Z <br />Water heater <br />Gas fireplace <br />/ <br />.� <br />Dishwasher <br />Clothes washer <br />Z <br />/ <br />Gas range <br />Clothes dryer <br />Range hood <br />Water heater <br />Sink (servicelbarlmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />__ <br />__ <br />_ <br />1_ <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />_ <br />_ <br />_ <br />_ <br />Floordrain <br />Woodstove <br />Grease trap <br />Roof drains <br />Other _ <br />__ <br />-- <br />Other — <br />_ <br />_ <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 />oruinaces 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 hority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />cons ct n. That I am a o e by the owneraf t for <br />to perform the work for which application is made and I comply with the <br />Sta C tractors Law 2 and 296.200 C. <br />_ L Zz. l <br />I/ <br />