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PtRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 5-- a-3-05- <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # <br />PERMIT # <br />/-7 <br />LEGALL LOT NO. <br />BLOCK <br />TRACT <br />DESC.f 3 <br />PLAT of EVeRFf VoL 3 ? 32 <br />OWNER ADDRESS CITY/ZIP PHONE <br />_ guf rlc. Van S4r;{ ['111, E.'tre q!444 33q-013y - <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Mike Lztoe,, Kos- 3a7- aA 35-- <br />CONTRACTOR/,a t-5en COnsf ADDRESS l CITY/ZIP PHONE <br />9AS- 4T't R50o70M115h 3a7-a53S <br />CONTR. LICENSE # <br />LARSc'C �lE IDf Dhl _ <br />_ <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />( y <br />.%.Electric Gas Other <br />WORK DESCRIPTION p <br />RemPc�e� Sa��� iUeti aj y,,q}er- <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 />1 <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />I <br />Water healer <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwashei <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />Flange hood <br />_ <br />Sink (service/bar/mop/etc.) <br />= <br />Exhaust fan <br />_ <br />BackBow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 />o,dinaces 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 properly to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW an" 196.200 WAC. <br />%A s-r3-oDa I <br />t <br />Signature of Owner/Contractor/Authorized Agent Date Z <br />