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PLRMIT 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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -6 —0& <br /> SITE ADDRESS PARCEL TAX I.D.# P RMITM <br /> L I Q0o 1700 <br /> LEGAII LOT NO. BLOCK TRACT <br /> DESC. 170 11)J 00 f Rl NIRIZ <br /> OWNER ADDRESS CITy/zIP PHONE <br /> UWv WICIAAEL 4 —14min lI 1-117 Ll i SC FuERETjr �.��fi `3�57v3-3S.3t <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> "" I SoC MUELLU (425) (aM -''DSA <br /> CONTRACTOR 1Zr NASc.rW1 florO F S.LLCADDRESS CITY/zIP PHONE <br /> &(vas)3so-(oSTs/ <br /> CONTR.LICENSE# <br /> IINd11 - 142 Or NE WLIA)b1-1PA) qq�,Vz <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> RFsf 145-VLF I —Electric X Gas—Other <br /> WORK DESCRIPTIONp1T1orj nr-,1 r-O 8f-I( OF NvMF_ Oos-(, sarr) <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 2 Toilet A/C–air handling units <br /> Balhluhr5i"t Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> I Clothes washer I Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan )I I <br /> _ Backflow preventer Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boller <br /> T R frigeration <br /> _ Floor drain <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <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 /> ordinates governing this typo of work will be complied with whether specified heroin or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other slate 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 /> Stat ontrac!ors Law 18.27 RCW aannd,96.200 WAC. <br /> re of Owner/Contract rlAulhorized Agent be (/� <br />