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PUMIT APPLICATICA <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 B AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />Jr 1 C AUUKC55 PARCEL TAX I.D. # I PERMIT # <br />SUS- Fo�`� SEsc� y/z�-cuo_�9-aa�os— LEGA LOT NO. BLOCK TRACT Co5a3-orJ2 <br />DESC. <br />OWNER ADDRESS C1 rV21P PHON yZ1 <br />Tf4r-(- (c- sj,3 c F,'r - & 5k s�J I.i/�rc+E 9�zo3 337 nlru <br />TENANTNAMECONTACT FOR PERMIT PHONE <br />i (g7QJt S I `itNrLti nAC\ m /0,(2K 16- IT c#3, t�+l,�yz'l J7/-a� Z 6 V.& <br />CONTRACTOR ADDRESS <br />NE <br />i l f s(o fah 5�w�� ley 1i1 � % 1Say SUa -7 LyImL.10C 21 r 7j,0 D(yt1� � 7/-09ZG <br />CON rR. LICENSE # <br />WL'6C0C017 7 7P 7 Az.T7 <br />USE OF BUILDING ll HEAT SOURCE <br />U <br />2LO( IC { h w 1�hdr' I —Electric t Gas _ Other <br />WORK DESCRIPTION <br />-1�}� Lis4eD 4)4 n c�ot�1 i re d 7vc� t�,y <br />T-rcuck A0,1-q 4 S <Y <br />CONTRACT PRICE OF WORK <br />V/,0o <br />PLUMBING MECHANICAL <br />TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />NO.rDishwasher <br />_ <br />(wash basin) <br />— f <br />& disposal __ <br />_�_ <br />Laundry tray _Range <br />Sink (service/bar/mop/etc.) _ <br />w preventer <br />Urinal — <br />Urinal <br />Drinking Fountain <br />Floor drain _ <br />Grease trap <br />Roof drains <br />Other <br />NC —air handling units <br />Forced air systems <br />Gas i In <br />p piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothos dryer <br />hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslo e <br />(y .. __ I, / urh <br />Other—ISCei�rn <br />— <br />— <br />— <br />—ink <br />— <br />—washer <br />— <br />— <br />— <br />— <br />— <br />— <br />_ <br />— <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I nereoy comity that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces 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 guthorily to violate or cancel the provision of any other state or local taw regulating construction or the performance of <br />const do ulhorized by the owner of this property to perform the work for which application is made and I comply with the <br />Stale ntractors Law 1 . 7 RCW and 296.200 WAC. <br />3— r-6,5 <br />ot Owner/ContracturtAumorized Agent Date <br />—_ �— <br />