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PLRMIT <br />APPLICATRA <br />CITY OF <br />EVERETT PERMIT SERVICES <br />3200 CEDAR <br />STREET, EVERETT, WA 98201 <br />425-257-8810 <br />— FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM <br />8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS 3,50 <br />PARCEL TAX I.D. # <br />PERMIT# <br />PL. N. E <br />201 oi-o-q 00300k0 <br />nt�,c)'S-oc(o <br />LEG A LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER <br />ADDRESS CITY/ZIP PHONE <br />C lLTC i E,r <br />PG. &x W)k q 1 I Z '76 -3 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />lQu-ne <br />VIc Eor G k (e ri 5 b <br />CONTRACTOR �,�� iur k E K LCY � f r SCgADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE IN <br />' <br />Syr(j�r b(fi �YYt 1 N r �1/ /l <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Yil� C A <br />X Electric _Gas _Other <br />oC <br />� <br />I <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water healer <br />_ <br />Kitchen sink 8 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 />_ <br />Sink (service/bar/map/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Rsfrigeralion <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE 13 3105 <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 <br />with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision <br />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 18.27 RCW and 296.200 <br />WAC. <br />`^C Cf /�( <br />5 6-,/ 10 S <br />- x <br />Signature of Owner/Contra or/Authorized Agent <br />Date <br />