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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 />11701 APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />J <br />SITE ADDRESS PARCEL TAX I.D. # P�iMIIT# <br />Pla-epe�eis Place_ 1oos�3g000-ova ooJrn -� S// 0>� <br />view <br />LEGAL LOT O. BLOCK TRACT <br />DESC. ?at r%3 -00 5r•L✓Lr/Z. <br />OWNER ADDRESS CITY2IP PHONE y26-as('toll0 <br />NoVlg8Trr?— Avc S %ur Wo T8o3Z <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Lj2S-651-6-7Y35 <br />WAtJue PbHQ,-. <br />CONTRACTOR �� BE T%Ezm�N�ij ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING SINS le -I 1 <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />1� <br />R,e51 C.� a 0ki4 (CouUOwu(u, <br />_ Electric VGas _Other <br />/051 Qn• Ob <br />WORK DESCRIPTION <br />10 CaNSrn,ACrr- 1 S%NraLC -F-Arid Dev'cw A 0-'0MDoK; MLtwk U"IT <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITERI NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C - airhandlingunits <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />I <br />Kitchen sink 8 disposal <br />Gas (replace <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />Laundry tray <br />Range hood <br />I- <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heal pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floordrain <br />Refrigeration <br />Grease trap <br />Woodstove <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 be true and correct. All provisions of laws and <br />ordinaces 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 />construipition. 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 n to Law 18.27 RCW 200 WAC. <br />2/- <br />Si atu of Owner ntractor/ u orized Agent Date <br />fit <br />