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I- ERMIT APPLICATIuN <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 1 — 6 —10 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />�S l` - 1121 Sl <br />0055 � Oct <br />iv! 100i ' 00 �7 <br />LEGAL LOT NO. <br />_ <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />000 6 S'T Fvl� fZL-R , q'5Ze r <br />TENANT NAME <br />I CONTACT FOR PERMIT PRONE <br />EMAIL <br />TR ' DDRESS C TY IP I <br />`� SCoD��Y��9 l lt' 7 ?,�-, jqq-'73C%lc <br />CONTR. LICENSE q���lettc�- 139 K K 500 E l�i b fj w q WZ— <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />iC Electric Gas Other <br />u 44V]. <br />4V]. <br />_ _ <br />WORK DESCRIPTION ,(� T \ 1 V1 G-F eSS �- 19() JT) 1) buA I � � <br />�0( `jJ�ri <br />1a1J <br />1 r� �2�s 1 tri eE <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />AIC — air handling units <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Water healer <br />_Shower <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />_ <br />Sink (servicelbarlmop/etc) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heal pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grcase trap <br />Woodslove <br />Roof drains <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify 1)al 1 have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinances 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 />Slate "tractorsLew 1U.27 C 00 WAC. <br />Signature wnerl roc rlAulhorized gent Date <br />