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PERMIT APPLICATION <br /> CITY OF EVERE17 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 /9/0 PARCEL TAX I.D.R RMIT 0 <br /> dl <br /> r�.103 nnr>n �On3 <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> S,Zc Cewf-e ` IIC- 1193.2 Ng 99'1 Sa44-Na WN MIS <br /> TENANT NAMECONTACT FOR PERMIT PHONE <br /> Iu IjarYnj yqS 506 - art �{O <br /> CONTRACTOR � {r llK Mcc.lwa;k,l �ntL. ADDRESS I7Lg4 I S b gOE SE CT'21P PHONE j j2y-_g'Ls6 <br /> x, lc. lu.1 3 <br /> CONTR.LICENSE A Hill CYCC 1if WA <br /> M;UENrocn De.- NI�IICrccic `7'dol� <br /> USE OF BUILDING HEAT SOIIRCE CONT ACT PRICE OF WORK <br /> Electric _Gas_Other <br /> WORK DESCRIPTION <br /> H.t 1O,fOCf QcSa-rbor-AS <br /> PLUMBINC MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR REM <br /> Toilet _ NC-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash hasin) _ 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(servicalbar/mup/etc.) _ Exhauat fan <br /> _ Backflow prevenler _ Heat pump <br /> _ Urinal _ Unit healer <br /> Drinking Fountain Boiler <br /> = Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TUX CODE IS 3105 <br /> 1 hereby cenllfy that I have read and examined this application and know the sama to be true and correct. NI provisions of laws and <br /> ordinates goveming this rk will be complied with whether specil,-,'herein or not.The granting of a permit does not presume <br /> to give authonty to le or can the vision of any other slate or local Law regulating construction or the performance of <br /> construction.Th am aujhon owner of this property to perform the work for which application is made and I comply with me <br /> State Conba LAW 1 I WAC. <br /> gnalure ofthorized Agent- Data <br /> r <br />