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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 G a S U <br />SITE ADDRESS <br />- neevai+ HW <br />PARCEL TAX I.D. # <br />1—'-3 <br />PERMIT # <br />70f', J <br />12e,Ig5 P�oihelI <br />LEGA LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS I /ZIP PHONE <br />�ycrei� �oFlool t�iyl. 2 4730 Galby Ave. t vOreR 'tZ5yi5-41go <br />TENANT NAME ��,,,, <br />CONTACT FOR PERMIT PHONE.42,5 -1 (-7 - 00 17 <br />�^'�"1 GriFFiv� <br />Vui '-ItLe <br />�Il L'letwey►katy <br />;7 'E�4 IiLFalar�hl�ec:'`y�P, jkc <br />�Ie : <br />�l^ 0J a <br />CONTR. LICENSE # I J <br />?' <br />1 v <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />�&m. p6r�n6le GI U5rYY'GOM114I <br />✓Electric Gas Other <br />C`JOd <br />WORK DESCRIPTION nP� r� <br />60j%,, yucl` -PoNndafl crnS OM4 ►'Amps �Or aGcB55 iar J eiXi' 'fl 19 <br />( r4v' W e bLAIW i hq s (4o lie Kelooaked M+ ';�'avne gd* *11-e-) <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />110. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — aiihandlingunits <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />Kitchen sink 8 disposal <br />_ <br />Gas firep!ace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />_ <br />Ranoe hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />__ <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />_ <br />Roof drains <br />Other_ <br />Other <br />CITY 01: EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify that I have read and examined thi; 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. T'he 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 Contractor aw•1B.27.RCW and 296.2C0 WAC. <br />--7 <br />f�%M ��- , 2i'd f <br />Signature wner/C tractorlAuthoraed Agent Date <br />l <br />L' - <br />