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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CED/,R STREET, EVERETT, WA 98201 <br />_. 425-257-8810 — FAX 425-257-8857 — wv w.everettwa.org <br />�7 I 3S S� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # ,N %ff-82I .Of5 ( PERMIT # <br />'ti ' <br />c txt`�369-g21-Ol�l-oo <br />LEGAL LOT NO. B OCK TRAr.T <br />DESC. \0 15- lb_ Z1 �L�"' o-F auk -TT pliltsio� A/I tJ3 (o <br />OWNER ADDRESS CITYIZIP PHONE.,.-r 4- 3 O <br />S <br />S+M �RdLTN4aRS 1S13o- (} G).1+uq CWA Oe &Ai,I,CR���A C(% 0 k?- <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Q 4D <br />M-'V-te" -robt> yzs--7S-i-83 8 n <br />CONTRACTOR ADDRESS CITY/ZIP . PHONE <br />FAQ 0-cl Ccw>TrzSiJL Q.O.Bo>; 1�39 S6.uoltiorKtS�. y25-75`i 83Q0 <br />CONTR. LICENSE # <br />5TA2(L CtCig`I UCI� (^� aTRGT QkRSeN t`n�bc�e.'%p� <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />2rey,d,�,rtcP1_ l�+Vtlr4 up <br />Electric _ Gas _Other <br />523� ooy <br />WORK DESCRIPTION fi <br />CousZnocr TWO l2, - aot:%-d�j5 <br />S tTda WDcziA, = wUSYLIcl <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />No. TYPE OF FIXTURE OR ITEM <br />Toilet <br />AIC - air handling units <br />_ I <br />Bathtub <br />Forced air systems <br />1 <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />Water heater <br />_ I <br />Kitchen sink & disposal <br />_"Gi <br />s fireplace <br />_f <br />hwasher <br />Ga nge <br />Clo s washer <br />( <br />Clotha ryer <br />_ <br />Water h er <br />Range he <br />_ <br />Sink (servic r/mop/etc.) <br />Ll <br />Exhaust fan <br />Backflow proven <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration. <br />— <br />Grease trap <br />Woodstove <br />Roof drains <br />_ <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify 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 property to perform the work for which application is made snd I comply with the <br />State Contractors Lpw4g.,27 RCW and 296.200 WAC. <br />- 12Zo6 <br />Signature of caner/Con racl d. uthorized Agent DaIte 1'y <br />J <br />