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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 <br />SITE ADDRESS <br />PARCEL TAX I.U.11 <br />PERMIT # <br />LEGAL LOT NO. <br />DESC. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />OWNER ADDRESS CITY(LIP PHONE <br />nlftbi 502Es --r-AV 2 sk 2� 32"':' r S7? i 7-0 �A, of 7y13S <br />TENANT NAME <br />MG �EQ- �� �7SfS <br />I CONTACT FOR PERMIT PHONE <br />c L -S/ c- 7�-- y <br />(5r`IHi-),SOv1'f'hE-MAIL i,r ccn.5�,+rv�re, pit <br />CONTRACTOR T12uc-->"r--,,a Nc%/ jADDRESS � yS /"'` si CiTTii21P I m <br />-ET- <br />CONTR. LICENSE/ -h 5Er I JUNtiN/(iIL! a5?$26 ybyC <br />iZLic 77V-K l�✓a cf60 <br />USE OF BUILDING <br />I — HEAT SOURCE <br />Electric Gas Other <br />I Cf �Qe0ONTRACT PRICE OF WORK <br />me 3� <br />WORK DESCRIPTION <br />P-IePbt-6 AV6 RE/-Oei 16-fei -rE �s <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water Heater <br />Sink (service/bar/mop/etc.) <br />Backflowpreventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />_ _ <br />_ <br />_ <br />j <br />_ — <br />A/C - air handling units <br />Forced air systems <br />Gas'piping <br />Water Feater <br />Gas fireplace <br />Gas range <br />Clothes dryer - <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other -- <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />CITY OF EVERETT LOCAL SALES FAX CODE IS 3105 <br />1 hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions o! laws and <br />ordinates governing this type of work will be complied with whether specked herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other slate or local law regulating construction or the performance of <br />construction. That I am authofrzed by the owner of this property to perform the work for which application is made and I comply with the <br />Stale Contractors Law 18.27 RCW and 296.200 WAG. <br />. 3,J�( <br />Signature of Owher/Contractor/Authorized Agent Date <br />J. CO41 1 <br />