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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 />PARCEL TAX I.D. #aO� <br />PERM�#� <br />r ! 1 <br />, n a <br />` <br />` 3 <br />'VVIINN,, <br />LEGAL LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION # <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />/� CW-12rr> <br />9T,2(23 �Izs 3�IFr-05 J <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />��Y, IIVMCNf� �� E-MAIL-G/��� <br />—CONTRACTOR ADDRESS CITy/zIP PHONE <br />D,9ti' d- /0 7-F RMI&5- d- -krC" IGGI i-I 134 kw-W. / [/ <br />q 7 <br />CONTR. LICENSE #J)� y1q I�/. &43 7 <br />%i / <br />`7 <br />OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />IUSE <br />X_Gas _ Other <br />_ Electric X_Gas _ Other <br />�I l � l � . Lit]Electric <br />�I l � � � . Lit] <br />WORKDESCRIPTION REPCf)CE Eocl5,nA* (5-iq-s Ftl�i11//i�L 7.14 ✓J�eiti <br />GAS- F-WRc, r4J 6A1v&,9, LOC NTIGYn <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 units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />_ <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Water healer <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />BackBow prevenler <br />Heat pump <br />_ <br />Unit heater <br />_Urinal <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />1 hereby eeritify 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 compiled 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 slate or local law regulating construction or the performance of <br />construction. 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 />SlatZC;;ZL 18.27 BCW and 288. <br />f 2AC. <br />SignatU wner/Contractor/Aul iz . nl Dale <br />