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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-,.vww.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS e Ver2-e-rr, <br />PARCEL TAX I.D. # <br />PERMIT # <br />5->�g�E• WA O1Q2o1 <br />SEeftGt1E'� <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. P L <br />E1156 5 E <br />OWNER ADDRESS CITYIZIP PHONE �Zv61 <br />lJ- <br />50L(/J'P 'r'2 rtiNs IT 4'OI 5. 3-AckcSoN Si. 19104 jcj$ S-000 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Solt.Na T Apj-c I T <br />I VAl- BATc`(, f?aysec-T �462• (S4::P6)2�"tS-�II� <br />CONTRACTOR ADDRESS CITY/ZIP PHONE /) <br />CONTR. LICENSE # �� �0 p C TrcQ I N f✓ �- / <br />ZDIv S <br />sC;1�1v,,, �d�—S�r �1e-•Ic,S& dry -T-/O <br />USE OF BUILDING'Fh PY-110cl, P (wi' <br />NEAT SOURCE <br />CONTRACT PRICE OF WORK <br />'t'fc(PS'f r:A+� pvGt I�NSSr BNsr <br />✓ <br />- A �.X. 10 ♦IIIUon <br />�r <br />Optilaf ovs hl�� �ii Zv<c2oTT`S <br />pJ —Electric Gas_Other <br />To pElb2iUIN- <br />WORKOESCRIPTION Sur�gce r,u4 n� (5lb SFtItS), C> ue�l Pe.lts�ra� or.��4s5(�w� <br />G 1G✓w+"�5 4 54�'rs) r <br />I' loQ�ngi TtqU-/.w_ r7nCA, tLw.i(S cw(J in� r Ir r. GJ q-I'i JY�. <br />JJ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />1 <br />Toilet <br />I <br />A/C - air handling units <br />Forced -V) <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />— <br />air systems c..'I �; <br />Gas piping <br />Water heater (insia.�c.nco elc��+c� <br />2- <br />itchen sink & disposal <br />hwasher <br />Clo s washer <br />Laund tray <br />Sink (se ' e/bar/mop/etc.) <br />Backflow pre nter <br />Urinal � <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />b <br />_Boller <br />L <br />i <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Ran hood <br />Exhau fan <br />Heat pum <br />Unit heater <br />Refrigeration <br />Woodslove <br />Other f •1'.by } <br />61 < ct� r.4cr <br />_ <br />_ <br />_ <br />2 <br />_ <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 5e We and correct. All provisions of laws and <br />ordinates governing this typn of work :rill 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 authcrized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27ACW and 296.200 WAC_ _ <br />�l <br />Signature of Owner/Contraptor/Authorized Agent-j uateW S <br />�r x <br />i <br />0 <br />