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PIRMIT APPLICATIIN <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 -DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESSPARCEL TAX I.D.# PERMIT# <br /> ( II WTH St SG 00g71700do0Id o oyll- <br /> LEGAL LOT NO. ( BLOCK TRACT <br /> DESC. raj Otk'� At, <br /> 4111 <br /> OWNER q ADDRESS / r CITY2IP PHONE <br /> �MF-)2Al-b �I �-L�i 160 /VE <br /> TENANT NAMECONTACT FOR PERMIT PHONE <br /> ' /(k I FOC- J:�:: MME <br /> CONTRACTOR A1cFvD-nAQ Aj5ATSrApM' 1 DRESSS�} A CITYIZIP PHONE <br /> CONTR.LICENSE# Ap'FIn1> 100f ✓ 132 7/H�il A4 #"T WA �2f,2-0I <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> '7 <br /> Electric Gas_Other <br /> 3 � <br /> WORK DESCRIPTION <br /> -P4M6tA5VA 4xlsn�►G �i IRT1ntQ£ Q�MOJE p�SJ-IS <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C–air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> _ Shower Water heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray _ Range hood <br /> _ Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow preventer Heal pump <br /> _ Urinal Unit healer <br /> _ Drinking Fountain Boller <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I 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 nut.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 41horized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contrac s Law 8.27 RCW and 29(,.200 WAC. <br /> 4 j <br /> Signature o er/ o ra r/ uthonzed Agent �e <br />