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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />15I1 ('P5 d 5 <br />PARCEL TAX I.D. # <br />PERM T # <br />Q — <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />&QN I (ot0 a, SE 'a5-353 8-13 <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />CONT CTOR ADDRESS CITY/ZIP PHONE <br />van��d�cisitil�srnTne. 11�5G��-�Iwy9q <br />CONTR. LICENSE # RDYW VT — o �5T' , `l (b) <br />YW V Y 1 dJLJ�+ y <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />U <br />I _ Electric _Gas _ Other <br />1575 cc, <br />WORK DESCRIPTION <br />I,..SACLVIVLCA J1 -- L�.k-.IL►ka �, �v.�plq�� -lo �, sic��P <br />CS tZ� L — <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />T oilet <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water healer <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />_ _ <br />Gas range <br />_ <br />Clothes washer <br />i <br />Clothes dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />Sink (servicelbar/mop/etc.) <br />Exhaust fan <br />_ <br />BackBow preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodslove <br />_ <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 />ordinates governing this type of work will be compiled with whether specified herein or not. The granting of a permit does not prosume <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 authorized by the owner of this proporty to perform the work for which application Is made and I comply with the <br />St 1 Conlracto 1 RCW and 290.200 WAC. <br />Ib dt <br />Signatufa of Owher/Contra Date <br />