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F.lu 1^1-� . ,i*b, Lk. .., ,_, - V <br />PERMIT APPLICATION <br />CITY <br />OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />E' <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />P RMIT r: <br />- 3th <br />West <br />cx'?552S00000h70 <br />✓��l�%�-(j�c2 <br />LEGAL LOT NO. <br />DLOCK <br />TRACT <br />DESC. -A,#- <br />CH� ©11F rt 3 <br />. <br />OWNER <br />ADDRESS CITY/ZIP PHONE <br />Artk A- <br />P.O 03x L 91;Zt3 �yu15-3-gn5 <br />TENANT NAMI1 <br />CONTACT FOR PERMIT PHONE <br />TcN'C-Sc\z.ec:E�yrctk (42S)-7sY-3300 <br />CONTRACTOR F,ir.s4 Ph45�L Conc.}, Sv,c. ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />1V%rsAPG <br />9 g8� „-� P.o box 218�+ E�e�'t'[ % 98213 (425V513-02,29 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />C'lt�R)ii�� <br />Electric Gas Other <br />I — <br />;l lmn 0 c]�o. Ap}�rox <br />WORK DESCRIPTION <br />R 201Y,201 GAP. /3 &E <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE <br />OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />_ <br />A/C - airhandlingunits <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />_ <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heal pump <br />_ <br />Urinal <br />Unit healer <br />Drinking Fountain <br />Boiler <br />_ <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodslove <br />_ <br />Roof drains <br />Other <br />_ <br />Other <br />_ <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 />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 camel the provision of any other state or local law regulating construction or the performance of <br />construction. That 1 am authorized <br />b the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18. <br />d 6 00 WAC. <br />/ <br />L 15-22 =200& <br />Skjn'Mure o Owner/Contr or/Au <br />orized Agent Date <br />`�Z <br />