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I <br />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 q °'-`r I �W L Avc S" 11-� <br />PARCEL TAX I.D. # <br />PERMIT If <br />vv.'IZ� tJA `f32oa <br />Z8v513c)03Gg3oo <br />jj �pp.S'� <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE,;12j fjq-7,,.0 <br />/.4k)RC'N(Ir' .N• �020(rJ r'r��I,L'[:. AJtiO� AI,Z.b.27' IZC_:Hj Faille4r 04, 9t;20ij <br />TENANTPlil(ME <br />CONTACT FOR PERMIT PHONE <br />D40.5 J�[tf itLL E Z ING y25 - �15 ���/no <br />CONTRACTOR D.hJr� 5(_141.46LLCd W(. ADDRESS ZdfOG gg4.h CITYIZIP PHONE <br />r4o' ,.ia t :J A,r; re 2Y0 <br />yZ5 ��5- 9vL�� <br />CONTR. LICENSE # LJA `'7Yo3(p <br />i• <br />S.c` A�'S <br />�kJi. ran/ <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />dFl�lrt <br />_Electric ✓ Gas_Other <br />Z11 si S <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C—airhandlingunits <br />Bathtub <br />_' <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />_� <br />Clothes dryer <br />Laundry tray <br />icange hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backtlow preventer <br />Heat Dump <br />_ <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />—� <br />Floordrain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other_ <br />_ <br />Other <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br />1 hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinacE3 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 propeily to perform the work for which appltation is made and I comply with Vie <br />State Contractors LaY4 18.8.37 RCCWW and 296.200 VVAC. <br />Slgna of OWnet(Conlraclor/Authorized Agent Date <br />VL <br />