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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 f , <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE AD RESS PARCEL TAX I.D. # — PERMIT p <br />U ` 0''� Sra�T SC,L] `h�xi 130L�20�) Cam' +I <br />LEGALL LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS ZO10Z & -7 "r guy21P PHONE <br />�oTA ISC€ �i11 i ECL�02 USE'S C-C C &/l 343 AAA # kgVj O-LA - (217?L <br />TENANT NAME // I CONTACT FOR PERMIT PHONE <br />AJ Fein crzs- 3z� <br />CONTRACTOR SflA,tt7= �5 ,�fSOuc ADDRESS CITy21P PHONE <br />CONTR. LICENSE p Qo / A GOL-9 7 1 ALA -)USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric _ Gas _ Other <br />WORK DESCRIPTION <br />g D/v <br />ST(C�c'i <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />_ Toilet A/C — air handling units <br />_ Balhtub Forced air systems <br />_ Lavatory (wash basin) Gas piping <br />_ Shower Water healer <br />_ Kitchen sink & disposal Gas fireplace <br />_ Dishwasher Gas range <br />_ Clothes washer Clothes dryer <br />_ Laundry tray __ Range hood <br />_ Sink (service/bar/mop/etc.) Exhaust fan <br />_ Backfiow preventer Heal pump <br />Urinal Unit heater <br />_ Drinking Fountain Boiler <br />_ Floor drain Refrigeration <br />_ Grease trap Woodstove <br />_ Roof drains Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />1 hereby cerilify that I have read and examined this application and knew the same to be true and correct. All provisions of laws and <br />ordinaces 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 cancel 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 theZ <br />for which application is made and 1 comply with the <br />Slate Contractors Lew 18 27 RG1N�sId 298.200 W C. <br />If fir' Sys � <br />gnature of Owner/contractor/Auth d g t ele <br />