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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 />7 17 _3S APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDR1ESS PARCEL TAX I.D. N GC (9Cg-SRI'OIS-or.�•••- •• <br />��36q-gZ,-oN_eo Co,o - <br />IGAL <br />L • OT NO. BLOCK TRACT <br />DESK.f kLj hZ k)Lo ni &jkacJl t(0t510k) •1rl 0- l- ' o <br />OWNER ADDRESS CITY/ZIP PHOEtLgS'7C,•f. '3 O <br />S4-M 1,(;13o- R Cojnzq CA.46 Oe INA 1G CRta WA 4got2 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />QODt'A-- <br />Tobt> qv;-?S`{-83 8 c) <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />g-rA0_ Ccu>TrzzN�- Q.Q.ao'>< t�39 S(..tolnoM�S�. LkTS--7(;+9340 <br />CONTR. LICENSE P <br />ST'6'0_Q Cka9H N!&& Oo I`n�k� Topp <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />a�Cy�6�EwlrlgL �ytt c, Up, ty <br />Electric —Gas _Other <br />rjZ�� oo'D <br />WORK DESCRIPTION 4 <br />CouSZa�;Cr �o�) �TLOO l (_k - VLEy Rl�l �t�� <br />S kTdc. Lor)(Liv-, TNclut�vl c� �-W� G�Sc P'e <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 />Lavatory (wash basin) <br />Gas piping <br />_ I <br />Shower <br />Kitchen sink & disposal <br />_s <br />Water heater <br />fireplace <br />_I <br />_ I <br />+hwasher <br />Cloth s washer <br />/ <br />Cal,nge <br />Clothe ryer <br />_ I <br />Water h er <br />N <br />Range ho <br />Exhaust tan <br />= <br />Sink (service r/mop/etc.) <br />Back(low pre <br />Heat pump <br />\ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain �` <br />Refrigeration <br />Grease trap <br />_ <br />Woodstove <br />_ <br />Roof drains <br />_ <br />Other_ <br />Other <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 />ordinates 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 property to perform the work for which application is made and I comply with the <br />Slate Contractors L 27 RCW and 296.200 WAC. <br />t2Zo6 <br />Signature of wrier/Con racl r/ uthorized Ageo. D e l I L <br />