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F- 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.Drg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />t✓ <br />PARCEL TAX. I.D.0 <br />�200f t7 Qw� <br />PIRMITO 6 _ , <br />l� <br />INZo <br />p 5Gl <br />LEGALT LOT NO. BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />g2G C0 "► 11"t uq!f L LC. 413; Nr 11)74-11 Seirioeiq llS <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />*Te)v p- 7b3-17q I <br />.e0 <br />CONTRACTOR �VerqWon Pe Hi /" drADDRESS-727 S. �y vll CITY/ZlKeA"I(PHONETV4-7Pj-t7 <br />C111ira <br />CONTR. LICENSE #EV F n jt� /%1 (A 5Q P_2 <br />Y L 141` ��{� �'1,J 1 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />_ Electdc _ Gas _ Other <br />5 GQ a <br />WORKDESCRIPTION J" ALP ly,L re) 9e i9p <br />VA1j- Oucfl-'ylft +i, �SCrfi 9qJ prtorr+r� Fv✓1f71mt vf71)ellfhl� <br />V-11 IVAK . <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling unite NV/,C <br />_ <br />_ <br />Bathtub <br />Forced air systems <br />Gas <br />Lavatory (wash basin) <br />piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />__ <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (servicetharlrnopletc.) <br />_ <br />&hausl fan <br />_ <br />Backfiow preventer <br />Heal pump <br />_ <br />Urinal <br />7 <br />Unit healer <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodstove <br />_ <br />_ <br />Roof drains <br />_ <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <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 />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 aul brity to violate or cancel the provision of any other slate or local law regulating construction or the perfomance of <br />That I by the owner of this property to perform the work for which application is made and I comply with the <br />construct! am authorized <br />State o tors Law 1 7 ROW and 296.200 WAC. <br />�/13/eG <br />Signet Owner/ 0 clot/Aut rorize gent Date <br />