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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 ✓ �� —12 <br />SITE ADDRESS <br />�w <br />PARCEL TAX I.D. # <br />I <br />RMIT # <br />'?�S-lac' <br />(28!°> iz�a�ell-�✓evef% <br />Zflo�L'►od303�-00 <br />� <br />LEGA LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYMP PHONE <br />�rvc ti 7; kool r%lStYfG� h730 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE3 fly� �jo f"i <br />�%IIVC:I/ ��K�(: Y�IEVi1fVlT�,1Y'y 5�\. <br />y-f215 <br />`(G�i'\ L/}�( I �f'1 E-MAILIOir•LA I IGI�r�h;�ec. <br />v0 A,L4A <br />V\j 7i ckn-'s (4407 woke y tiirf (3Iv4 . <br />CONTR. LICENSE# MotrySvlllc +OZ71 3600 0U <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />,, <br />- 60(2 • pok+,A6te Ye9i'11Y0dm I <br />✓Electric —Gas —Other <br />I 31 GdG <br />WORK DESCRIPTION <br />(rt�tAll -1GU4�ai-Il•'r �D'� �Ur}a}�ie re5-I'room bc,�ildilni <br />XISIINu] E70YAble IrG�fl"uUl1n fre(OGu+ed P1100\ aro}I^er (� �dCA�ldr 1 <br />/ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />_ <br />Water heater <br />_ <br />_ <br />IG•rhen sink & disposal <br />_ <br />Gas fireplace <br />C-simasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />Urinal <br />_ <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <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 wort, 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 />State Conlraclors LpW 1827 RCW and 296.200 WAC. <br />--(w uftu• 5'2I-0`j <br />, <br />Signature of Owner/Contr ctor/Authorized Agent Date <br />S <br />CT <br />