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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 />ADDRESS <br />PARCEL TAX I.D. # <br />P MIT # <br />rSITE <br />{ <br />LEGATLOT NO. <br />DESC. BLOCK TRACTOR SUBDIVISION # <br />(mid/D <br />OWNER ADDRESS CITYr: �P PHONE <br />��AC.G��'S Crr�n�Ja�-` � lal I13t'��e/IIG�eIb3ilG�l�1 <br />,NI�3 <br />_1�1- NTACT FOR PERMIT PHONE <br />TENANT NAME ---� CO <br />trc��e/t 1pI1PS� E-MAIL �g('(,t)NE /AC�OJ/�-r�4 <br />y <br />Z,`(iFli A Lpr31-vn�e C-cx4rc c f": Abb�� S,A'U V7ekP, r 4I YrZIP 30 _t0 0 _ U3 �to <br />CONTR. LICENSE # f Iioh o ai rsh/ WA Va.ga <br />USE OF BUILDIN3 <br />HEAT SOURCE <br />Gas Other <br />I CONTRACT PRICE OF WORK <br />! r <br />Electric _ __ <br />/6 <br />WORK DESCRIPTION I R�MQV� RoG+ il�lgnsa✓Ci reNet,✓ <br />pe=f�-rcV1�3v�l��nc <br />rUo�ingwetr/let,o4�r7�1 .�, K2 1�veafiMC�ongla(`S ITcry j5��tb/fPe�rrcu� <br />QI I '14Y or'oeg I nC <br />PLU NG MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C - air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />rNO. <br />Gas piping <br />Water heater <br />_ <br />Shower <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />_ <br />Dishwasher <br />Clothes washer <br />__ <br />Gas range <br />Clothes dryer <br />_ <br />_ <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Range hood <br />Exhaust Ian <br />_ <br />_ <br />Backflow preventer <br />Heat pump <br />Unit heater <br />Urinal <br />Drinking Fountain <br />__ <br />Boiler <br />Floordra;n <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />__ <br />Woodstove <br />Other_ <br />Roof drains <br />_ <br />_ <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application 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 />co t(uction. 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 />S t . Contractors Law 18.27 Wan r2 AC. <br />r v i <br />Sig alure of Owner/Contractor/ uthonzed ent Date <br />L — <br />CO//) <br />