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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 <br />SITE ADDRESS <br />SEOka <br />PARCEL TAX I.D. N <br />PERMIT p <br />p 91S�Pt <br />0069//0000/60� <br />LI-GA LOT NO. BLOCK <br />TRACT OR SUBDIVISION p <br />DL,C <br />OWNER ADDRESS CITY/ZIP PHONE <br />�1�KGE L Oc�'EM�� Z y�(f �d/ f rPc SF cbwfl T `/' m 42s-42 Z- <br />TENANTNAME I CONTACT FOR PERMIT PHONE <br />t;LUI- FI_AM 1- t LL -711 u 2- <br />CONTR. LICENSE R <br />BLyE G L+ gej-1 RI <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />SS(C � n 7 ee <br />✓ N�(E r AYM Electric Gas _ olncr Sim <br />I <br />WORK DESCRIPTION <br />vv/ A)cil 1/c <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OP. ITEM <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />toilet <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />__ <br />Gas piping <br />Shower <br />Water healer <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gasrange <br />Clothes dryer <br />_ <br />Clothes washer <br />Water healer <br />__ <br />Range hood <br />_ <br />Sink (sorvicolbarlmop/etc.) <br />_ <br />Exhaust fan <br />Backllow proventor <br />— <br />Heal pump <br />Unit heater <br />_ <br />_ <br />Urinal <br />Drinking Fountain <br />_- <br />Bailer <br />Refrigeration <br />_ <br />Floor drain <br />Grease trap <br />Woodslove <br />_ <br />_ <br />Root drains <br />Other_ <br />Other _ - <br />-- -- — <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 0105 <br />I hereby ceritify 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 />local law regulating construction or the eeiformance of <br />to give authority to violate or cancel the provision of any other state or <br />That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />conslrucion. <br />j Stale Con r 7 RCW i id 296.200 WAC. <br />i OG <br />Signal o o10 / ctorl ul orized Agent Date <br />76 <br />OA <br />