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PLRMIT APPLICATKA <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everett.,qa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> .ko> - d� Pt.• SF_ t)0 Wsk\Vioccz� kqD1 �. 060t - 03 (0 <br /> LEGAI. LOT N0. BLOCK TRACT <br /> DESC :` 1 x.,51 Cw-.YL) �l� ��fi• C'.J.�lt�-�C,}�u��A <br /> OWNER ADDRESS CITYIZIP PHONE G <br /> 5AL' AC1 t5C 12�i OV, j 1 01 1 3 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> :. • f I: l_ .�,,, 1,k?aS\wa,� X17.a �'-.t `l�. l'R 14Y <br /> CO1TRACTORADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE# l '�J � 'k C\r'j•-- e.13-1 7t q <br /> - F10 (A a. 7, C II,C) <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> rc(J c� 1 Electric Gas Other <br /> _ <br /> WORK DESCRIPTION <br /> ArAA,� Q� 'C4-& <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 Toilet A/C--air handling units <br /> Bathtub Forced air systems <br /> L_ Lavatory (wash basin) Gas piping <br /> Shower I Water heater <br /> —L Kitchen sink 8 disposal _f_ Gas fireplace <br /> 1 Dishwasher 1 Gas range <br /> I Clothes washer I. Clothes dryer <br /> I Laundry tray I Range hood <br /> _ Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> Grease trap Woodstova <br /> U Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7103 <br /> iI hereby ceritify that I have read and examined this appliration 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 peril does not presume <br /> to give authority to violatr 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 property to perform the work for which app6caflon is made and I comply with the <br /> State Contractors Law 16.27 RCW and 296.200 WAC. <br /> Signature of Owner)Contractor/Authonzed Agent Date <br />