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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-885T= www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # PERMIT # <br />8053 000 %{o(. Zo U rC > $ GG <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC., <br />OWNER <br />AL)DRESS CITYtZIP PHONE <br />,d/f < N/I,•r <br />(� 16 <br />., L Sox }b I+zI2 1 r` ,d OR Q7-M <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE j <br />T-(PA j" <. <br />Inae- )/�rcty01- 83'5-/00 7 <br />CONTRACTOR A 'C <br />ADDRESS CITY/ZIP PHONE t/Zi <br />pljµ.bj� <br />- <br />CONTR. LICENSE ## <br />Iftrz <br />ALL WP-.rJtNMCI 21-'�t6 )Oe40464 PJy 0•6y 'el, 44 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />— Electric Gas Other <br />I 3Sbo — <br />WORK DESCRIPTION <br />-QCwt00C Rt- St4 <br />-�.r.) I.e . <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 />_ <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />Dishwasher <br />_ <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />Range hood <br />(sewicefbar/mop/etc.) <br />Exhaust fan <br />_Sink <br />Backflow preventer <br />_ _ <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />Drin'%ing Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodslove <br />_ <br />Roof drains <br />__ <br />Other <br />Other <br />--- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify that I have read <br />and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of <br />work will be complied with whether specified herein or net. The granting of a permit does not presume <br />to give authority to violate or cancel <br />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 Contractors Law 18.27 RCW and 296.200 WAC. <br />Slgnatu�f Owner/Con)tactor/Authorized Age Dale <br />