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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 PARCEL TAX I.D.p ,.PERMIT(r' <br /> I' 0``-' 51. �.v1 pa-69aa _oaa -dao -o3 D'7- / <br /> LEGAL CLO_T NO. BLOCK TRACT <br /> DESC. )eCjgi <br /> OWNER ADDRESS CITYIZIP PHONE <br /> mt,,-n 6AckUS 4932 Ne ii"i'- TT- G811C 206- 3/6- 5239 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 00vhT*-A Jlu.ttA l -3Wc . (41e(, �U.Et1MOEV4• �a6- 354. 3309 <br /> CONTRACTOR ADDRESS CITYMP PHONE <br /> �rJGSNt VLC� ?MY)iIAM -10— lU.'71 Aw-)ONL PA"W. 2n6-314-33ao <br /> CONTR.LICENSE 0 <br /> InM• 58 �b8 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> y\JNN{off^- _Electric _Gas_Other I '5:,/ Sys,n <br /> WORK DESCRIPTION <br /> `(-o ?R. VSnn `S►r55Au. �C�LAtL �I�LkaUG-. <br /> PLUMBING MECHANICAL <br /> VO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> _ Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> _ Laundry tray _ Range hood <br /> _ Sink(servicelbar/mop/etc.) Exhaust fan <br /> _ Backflow preventer _ Heal pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodslove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinoces governing this type of work will be complied with whether specified hereln 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.rade and I comply with the <br /> State Pontractr Lew 18.27 RCW and 286.200 WAC. <br /> SignbW,aocaner ontra lor/ ulhorizea gent Date <br /> /Z <br />