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PLRMIT APPLICATRA <br /> CITY OF EVERETT PERMIT SERVICES 'n <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 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT# <br /> 8-(I - lci 0 L.S 9 090 c:i< 911 C304-, 0 1 00 00 <br /> LEGA LOT NO. BLOCK_ TRACT <br /> DESC. <br /> OWNER ADDRESS a clTY/zlP PHONE <br /> Qa ,Lk'Q- 033L-aeFiU�SE I.aS1�- Vas - -1'13-11 ( $ <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> ( ya <br /> L,.,- \ L-k" lila Ills <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> f-: act R Cn11n��(�.� � 1'103) 3s�fl�� Sl' 3�9tLq�o1� 4as7�a 111g <br /> CONTR.LICENSE 0 <br /> USE OF BUILDING � } I -- HEAT SOURCE CONTRACT PRICE OF WORK <br /> Svn�l.t E rv+ ]�1 <br /> Electric Gas✓Other 1 7i6 tt.C;, <br /> WORK DESCRIPTION <br /> 't\1 e. iz' - <br /> v'1lu�aac� 1 '7 3, <br /> PLUMBING MECHANICAL <br /> NO. 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 /> I Kitchen sink 8 disposal _I� Gas fireplace <br /> I Dishwasher I Gas range <br /> I Clothes washer i Clothes dryer <br /> _ Laundry tray I. Range hood/ flu a C <br /> _ Sink (service/bar/mop/etc.) 5- Exhaust fan <br /> _ Backflow preventer Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fuuntaln Boiler <br /> _ Floor drain Refrigeration <br /> _ Greaso trap Woodstove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <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 /> iordinates 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 /> State Contractors Law 18.,227 RCW and 296.200 WAC. <br /> Signature wnen ontractou th nzedAgent ate ll. (�- .' /,i � <br /> 7 �2J <br />