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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 W _A�, <br />lbtb 3z�1 ( <br />PARCEL TAX I.D. # <br />oo-A Y\M b-1 03 1 uU <br />PERMIT # <br />LEGAL LOT NO. <br />DESC. 'j L 3?- <br />BLOCK <br />O(7 <br />TRACT <br />OWNER ADDRESS CITY/ZIP PHONE <br />`lLS SOy <br />��r n Lc rcJv) & 0 . 2-cl L n'_`Lh 01W )b (y I O <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />VV\VVM Nye <br />I Ak 0 <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />QAa Ll- 141liry Co.,,1. �1'0.� t,bZ2 NV 10o" <br />CONTR. LICENSE # <br />PA-T R I H C��l Icy 61�1 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />unc- , L e— <br />I <br />— Electric Gas _< Other 14 ` "^I' <br />'t] LJ CDv 'r <br />I <br />WORK DESCRIPTION <br />` <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />0 <br />Toilet <br />A/C — air handling units <br />Bathtub <br />Lavatory (wash basin) <br />Forced air systems <br />Gas piping <br />Shower <br />Water heater <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Range hood <br />Exhaust fan <br />BackBow preventer <br />Urinal <br />Heat pump <br />Unit healer <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />Other <br />I <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 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 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 />construction. That I am authorized by the owner of this properly to perform the work for which application is made and I comply with the <br />State Co tractor Law 18.27 RCW and 296.200 WAC. <br />Signature gPOwner/Contractor/Authonzed Agent D t13 e <br />