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i <br />P8RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />125-257-8810 — 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. A <br />PERMIT # <br />iisn strfri .W. <br />I -�).`60C1 I Soo a300o <br />cxoof3-oa <br />LEGAq LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE r yc5 <br />/t IrE f ffilr?/L1i S-;E �J.1200 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />( y1 S) 070 - /6,3 0 <br />CONTRACTOR 'Il R ADDRESS CITY%II PHONE <br />/� <•� N <br />CONTR. LICENSE 0 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />PMre'C J {r1TM �"<"'L <br />11 <br />I — Electric Gas_Othar <br />rJN.2 <br />I y1000•r.'0-r0NsNi14)0f <br />WORK DESCRIPTION J <br />qm..l s'<ia.. lnr,l ./F` �j - <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />Water heater <br />_ <br />_ <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow prevenler <br />Heal pump <br />_ <br />Urinal <br />Unit healer <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />__ <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY or FVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify 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 typo of work will be complied W.1h 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 />Slate Contract18..27 CW and 296.200 WAC. or La <br />y 4,14i4-A /7 6 <br />Signature o ner/Contra r/Authorized gent Date <br />