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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 —0 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMI # <br />/281s i30r//FCL- WAy <br />28os29oa3o74o0 <br />/a <br />LL-GAL LOT NO. —� <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY,ZIP PHONE <br />in crt c-r 7 - JekovL b,sror eT . •I7.?p Coc-p y A vC, Evill 78203 <br />TENANT NAME <br />FOR PERMITPHONE 346 • <br />Ire,r%> 9.O4R 7I/i t ^rjbc. <br />I <br />e • r. -0 R 2 <br />[3/7,S <br />— R•o rr JA/N Cr• .y E-MAIL tort l0 oll��' 0.rt�, <br />CONTRACTOR ADDRESS WIT'LIP PHONE O <br />eM.il�C--n e. <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />��AttRo.Mf - E1 GMCNf <br />Electric Gas oilier <br />G vj <br />WOPK DESCRIPTION 1 <br />t <br />P(acE �lJ 28 �t &P r Pof11-Tw9LC- AT "oo-T(( ep� <br />PCItv&L- - NFLCle-I%TIE FX_& cArr r'rf),�. <br />PLUMBING <br />MECHANICAL <br />140. 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 />'L <br />Lavatory (wish basin) <br />Gas piping <br />Shower <br />Water heater <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow preventer <br />Heat pump <br />., <br />Urinal <br />Unit healer <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Other _ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 31e5 <br />1 hereby cedlify that I have read and examined this a,;plicatien 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 stale 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 Contractors Law 18.2 RCW and 296.200 WAC. <br />Sig nal re of Owner/Contractor/ uthorized Agent Date <br />'�y <br />