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PERMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES � I �p 7- 7C) <br /> 3200 CEDAR STREET, EVERETT, WA 98201 U <br /> 425-257-8810- FAX 415-257-8857 www.everettwa.org n� 69 O7 <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# FRMIT N <br /> 3, 155- - CP1 b od>' 91SIo0co <br /> LEGAI LOT NO. BLOCK _ TRACT <br /> DESC. 11 - D S I A Ln'loxas ��'.•.".v__+ \ — <br /> OWNER ADDRESS C17411r PHONE <br /> P"V'L.2 n�,��run�n t,oaa ae�Ao�Se E ►� t4as <br /> t U <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> l—�N e �� duh 4Os - Yv3 - [, �4 <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> ha'tkl _ C--NA 11037 3s�A�� SC 3,NUtlk q-o0u. 4as7T3 Ill$ <br /> CONTR.LICENSE N <br /> USE OF BUILDING — HEAT SOURCE CONTRACT PRICE OF WORK <br /> SLc��I� h1 ,1 <br /> Electric Gas✓Other l <br /> WORK DESCRIPTION ,' l� <br /> tz.W O��-v'�'4��1-�L.c.�l o^n Ila l bm-N,A�-��LA-aclil.'�� <br /> t- <br /> PLUMBING <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> '3 Toilet _ AC-air handling units <br /> 9 Bathtub 5)at,a. I Forced air systems <br /> 4 Lavatory (wash basin) Gas piping <br /> Shower , I Water heater <br /> I Kitchen sink 8 disposal I Gas fireplace <br /> I Dishwasher l Gas range <br /> _I Clothes washer I Clothes dryer <br /> _ Laundry tray i Range hood 1 M%glr o <br /> _ Sink(service/bar/mop/etc.) _(Q Exhaust fan <br /> _ Backflow preventer Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boller <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> _ Other _ <br /> i <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I <br /> I hereby ceritity that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> I 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 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 application is made and I comply with the <br /> Slate Contractors Law 18.27 RCW and 296.200 WAC. <br /> Signature wnerl <br /> .ontractorrA h nzeo Agert ate �IZ <br /> I <br />