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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 PARCEL TAX I.D. # PERMIT # <br />9(oors i9-6AvC 56 ZtOS/S'ODgOs/Dd �}'!_- <br />LEGAL LOTB NO. LOCK TRACT <br />DESC. J-ff/S •��-3-Ff 8 <br />OWNER ADDRESS CITY/ZIP PHONE 425 927- 47 <br />c�boA/At{l-'.s -V6 t�oiwJ3 2. i�ii2iC.a..1?, 194-063 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />ft <br />Al.,Af+ WslC,„J6-m- 3k,a-Y16z-8-31b_ <br />CONTRACTORCp/S.rq,VE ADDRESS CITY/ZIP PHONE <br />C&An7ZA-CTal2-S 1910 'a"J'470r t /Fv"- Snoil 0-^1 S1. a6Q_ 8(oZ- 93� c, <br />CONTR. LICENSE # IrP Z'90 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />/ <br />�S 4 4Aj rdr. ✓L T- <br />_ Electric _Gas —Other <br />3 �' G p O <br />WORK DESCRIPTION <br />r/n9, sfavc ",,P -An fF?�A eo36-S <br />J <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />— <br />Toilet <br />_ <br />A/C - airhandlingunits <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />Clothes washer <br />__ <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />__ <br />Boiler <br />_ <br />Floordrain <br />__ <br />Refrigeration <br />_ <br />Grease trap <br />Woodslove <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 this application and know the same to he 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 Contractors Law 18.27 RCW and 296.200 WAC. <br />z (S aL <br />Signature of r�wn76o��Agent Date <br />1Z <br />:J <br />