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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 Z <br />SITE ADDRESS Ev&QM, Wr— PARCEL TAX I.D. S PERMIT R <br />8j,Z904` Si- Tw,i 4C /o Z8CzH iZ�3cS3�� <br />LrrAIJ LOT NO. BLOCK TRACT <br />OWNER ADDRESS .rrTi7p04 ^""'. <br />Sc't'd ye4'res SnC 3L�1�6N Av me f3eaievve , We, 20(a 19Juo <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />PCB;tJ IYLfioAS.7�.r�:nnl I 1o+eiF,EJ. `'s-7W'�2L$ <br />CONTRACTOR ADDRESS nITYOP PHONE %'?J 'Z3.% — <br />Q"Lw'O itl j,z.? `VS 7 C'1�S—) <br />CONTR. LICENSES <br />oRT,� vj <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />a <br />n os v Fa cA\, 1 c�rt�.ovS a —Electric �Gas _Other LSQ3' L <br />WORK DESCRIPTION <br />:S�r Y kr'o <br />Pcjqjk Rack <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />— <br />— <br />A/C — air handling units <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Disnwasher <br />Clothes washer <br />Laundry tray <br />Sink (serAcelbarlmopletc.) <br />Backnow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roofdreins <br />Other <br />— <br />_ <br />— <br />— <br />— <br />— <br />— <br />— <br />— <br />— <br />— <br />— <br />— <br />— <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other. <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this applicabon and know the same to be true and correct. All provisions of laws and <br />ordinsces govemi-1g this type of work will be complied with whether Specified herein 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 />constructloNThat I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contlar'tors Law; 27 RCW and 296.200 WAC. <br />/I - 2(o C)-7 <br />IL <br />