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PERMIT APPLICATIVN <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 . - a-�` �8 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />'S&-vo <br />PERMIT #. _ <br />CC) --oi-�) <br />- 2.l "D2. 1 L). <br />00'3` co/ /00 <br />I'/o <br />_4l <br />LEGAL LOT NO. <br />DESCj /� <br />BLOCK <br />DOUR-r.�C� <br />TRACT <br />I�LISH- C-r�}12t�cti�5 <br />OWNER ADDRESS CITY/ZIP PHONE C�Zy <br />(ryltTI ILP,,eP'r to, &GeE'T1td4 q$zo3 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />/VOG-TH-CP-c5-r t l/ C0413 P 0.3d7C 31-10 C11oloydg `i8C2v (YZO77'1-31451 <br />CONTR. LICENSE # A1012-TNG t�> I ssafq «.p. Z_lI /oo (2")1/nu <br />USE OF BUILDING <br />HEAT SOURCE <br />„CONTRACT PRICE OF WORK <br />SlA16CC r—Hirll"I % SrDE-�JL� <br />XGas <br />I <br />t4 jelf 2-1000 <br />_Electric —Other <br />WORK DESCRIPTION <br />RC-1.jf7At(_ EXISTIAJ6- /.atceoEL LtiICLI.ral�c- EuTtti'Sl�'t 7��n9c'Li7vA1 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />Bathtub <br />= <br />Forced air systems <br />Lavatory (wash basin) <br />-_ <br />Gas piping <br />7— <br />Shower <br />1_ <br />Water heater <br />—L <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />_/ <br />Clothes dryer <br />^, <br />Water healer <br />Range hood <br />_ <br />Sink (servicelbar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />_ <br />Woodstove <br />Roof drains <br />Other <br />_ <br />/ <br />Other Rau. )ce iri&Le✓ <br />_ <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 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 />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 />C'c1- L /I Z_/07 <br />Signature of Owner/Contractor/Authorized Agent I Dat <br />I <br />/ Z/ � <br />