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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CLDAR 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 --O'? <br />SITE A DRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />l - e� <br />"91OCK <br />a9 os - � <br />LEGAL LOT NO. <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />Eve,i &� +7 <br />TENANT NAME <br />L�'i l>/Cr �2k� Ele <br />CONTACT FOR PERMIT • PHONE. JTQlJ. J f �aJC <br />��i{�- �'o�GirUs E-rnAltc�C�LL <br />CONTRACTOR P A��� S n(��O r� n,' CITY/ZIP PHONE <br />NDRWI�/uc�Ais�S'/>u�GyV (! 11 /nKj SQafil¢ G0� 93103 <br />ATR. LICENSE # <br />A7i-FMSD-751-ky <br />USE OF BUILDING HEAT SOURCE PRICE OF WORK <br />#CONTRACT <br />Yr l Electric _Gas _Other <br />5j '8 ' <br />/ I <br />WORK DESCRIPTION /Yl ',f-��(,� C" ,V Q,7G 067>i <br />j��Qmo/r�1on o� �ure%ssrao <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />__ <br />Water heater <br />_ <br />Kitchen sink & disposal <br />__ <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Urinal <br />Heat pump <br />Unit heater <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />RefriS:ration <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 ceritify that I have read and examined ihis 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 />State C901rractors Law 18.27 RCW and 296.200 WAC. <br />�r fa/v� <br />.ice <br />Signat o _Ow /Co tr ct /A Ihorize Agent Date <br />