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f q <br />Y'oiK <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 p <br />425-257-8810 -FAX 425-257-8857 - Www.everettwa.org -O <br />r <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SI D� <br />pface SE <br />PARCEL TAX I.D. R <br />aoGos9a0000a- <br />PERMIT N <br />LEGA LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION N <br />DESC. <br />OWNER ADDRESS CITY2IP PHONE <br />l�-�sfuu- Rus5e�l q�u Pla�c.SE E�r��ttf `IfbroB `�s9a:-�Laq, <br />TENANT NAME CONTACT FOR PERMIT PNON�E`VD <br />�,"`�S��S� <br />/✓/� I '�r�nn � E-IlalllOLTW6Y-r!7 /(ttr. CVIO <br />�6RTiiA h1�� �1,IG-�t J'ua1 rg �gJO :lrr�U:r� 1r/l' � l4 Vy"7�/ � <br />5� <br />CONTR. LICENSE N J, r A�L� � ,. ngQ Q d� � , n GjfpOV s <br />r�•.Jr"r 7` / 1 riv_- ru <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />L Electric _ Ges _ Other <br />WORK DESCRIPTION chmiy aAl�, <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF Fl%TURF OR ITEM <br />N0. TYPE OF FIXTURE OR ITEM <br />Toilot <br />A/C — alrhardlingunits <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Shower <br />_Gas <br />piping <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />_Gas <br />fireplace <br />_ <br />_ <br />Dishwasher <br />Clothes washer <br />_Gas <br />_Clothes <br />range <br />dryer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />_Exhaust <br />Range hood <br />tan <br />_ <br />Backllow provenler <br />Urinal <br />Heat pump <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Floor drain <br />Boiler <br />Refrigeration <br />_ <br />Grease trap <br />Woodslove <br />_ <br />_ <br />Rool drains <br />_Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE 19 7105 <br />I hereby cerltily 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 />to give authority to violate or canoe! the provision of any other state 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 />State Contractors Law 1627 RCW and 296.200 WAC. <br />'L —t2-p <br />Signature of er/ on rector/ orizod gent — ate <br />