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P "RMIT 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 />�%)/)(r} /�� APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />/ <br />SITE ADDRESS <br />'II PARCEL TAX I.D. # PERMIT i <br />�z"—` S1•SE Ever 74 Wq. �� `J0030o700 l/.` t <br />LEGA LOTVNO%Ii- BLOCK TRACT ORnSUBDIVISION# �/I'q �•'+� N�'S pr'�' /`el, Jp•� <br />DESC. for 3 P)9*�c rr �f� h V6 g.�t Q7�4f: Oh c j� (Iec', or -C.� <br />Nqs+/r oT <br />OWNER ADDRESS CITYIZIP PN NE <br />OWNER <br />C rql'o IWA-f "205 y2S'�gy 1728 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONEFy a f1-3( rlyn <br />/ d <br />1� A <br />M1 `: Q OSe E-MAIL/i`fc K,�N'1 �j mAM'e$ <br />-to <br />FLiek,�IGfY }Ie.ylc5 76�1-�s�y�e �r tvcc 1 y?S• 3I4-S75 <br />CONTR. LICENSE A / �CI 3 <br />3sQ R <br />_ <br />USE OF BUILDING CONTRACT PRICE OF WORK <br />=ElectdGUasher ��� 79 <br />WORK DESCRIPTION , �% <br />r 1 I COHSl- e:5:44 Q� CO►I cp:O WWI I'1 I ivy) S <br />15[S�cf� ICI mew, <br />— PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toile[ <br />A/C - air handling units <br />Bathtub <br />Lavatory (wash basin) <br />Forced air systems <br />Gas piping <br />Shower <br />Z <br />Water heater <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Z_ <br />Dishwasher <br />Clothes washer <br />Gas range <br />Clothes dryer <br />J. <br />Water healer <br />Sink (servico/bar/mop/etc.) <br />Z <br />Range hood <br />Exhaust tan <br />Back9ow preventer <br />Heat pump <br />Unit healer <br />Urinal <br />Drinking Fountain <br />Boiler <br />— <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Roof drains f r s <br />to <br />Woodstove <br />Other <br />Other c <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 0105 <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 complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancol 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 />State Contractors Law 18 27 RCW and 296.200 WAC. <br />�ti� I - fi-/0-09 <br />Signature of Owner/Contractor/Authorized Agent Date +/Z <br />