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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.everetiwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. p <br />PERMIT <br />LEGA LOT NO. <br />DESC. <br />BLOCK <br />TRACT OAR/ SUBDIVISION R'jn�\ <br />&V141 Z <br />f 20 ZI - rT l-aCIS UIVr���yl <br />OWNER ADDRESS C VIZI PHO <br />m g PN <br />��u �h�ho111 `46 <br />M 1,�1� IS �ass 3;�d <br />f fc I Mc- u �c � k''s� <br />TENANTNAME V�l� <br />CONTACT FOR PERMIT PHONES.y),-887(o <br />I �tV,'`I" �� <br />I 6ir � r� <br />E-MAILM1I(helk—y S0 dl <br />Illy exlevlcvS,1N� INJO Pe'si-SW,5�F .lN qB 9 %$�CIoS'ISD� <br />CONTR. LICENSE N A A aT WeI3 ,b A <br />USE OF BUILDING Ad11U11 rj i a4iv-e- <br />HICAT SOURCE <br />COJdTRACT PRICE OF WORK <br />(( <br />iQI'i«t�7d'1 I <br />_Elacl.fc XGas_Other <br />WORKDESCRIPTION ur�[1'tij SjrI,711" o:7'V1'w� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />is piping <br />Shower <br />' ter healer <br />_ <br />_ <br />Kitchen sink 8 disposal <br />Gbb fireplace <br />Dishwasher <br />Gas range <br />_ <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />_ <br />Range hood <br />_ <br />Sink (servicelbar/mop/oic.) <br />_ <br />Exhaust Ian <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boller <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodslove <br />_ <br />Root drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby coriliiy t I I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinate Bove Ing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give ulhor to violate or cancel t11 provision of any other state or local law regulating construction or the periormance of <br />cons lio at I am authorized y th owner of this properly to perform the work for which application is made and I comply with the <br />Sta Co do saw 1�.27 RC T+pd 2 8.20� � . <br />3 <br />/ CC4/ v/ l3 D9 <br />Ignalure o er/ Onlraclor/ ut 0 a gent ate <br />1 <br />