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PtRMIT 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 1k,51 AD <br />SITE ADDRESS <br />PARCEL TAX I.D. # P RMIT# <br />LEGA LOT NO. BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONEyrs' o �j <br />+ � 1rr l�' �..i�r.2 �i?. Y• 5 PI''l /31 � 3 5 3 a v yu z D/ Art, ✓ �f 7z3 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />ReAeW ions=1,- dFj/6 <br />CONTRACTOR -L't 1e 1.r5 v ADDRESS �M Q ,�,{ 35 j CITY/zIP PHONNz� <br />74C <br />CONTR. LICENSE # /�lT f�'%CL �/ % I /H k✓ 2 eJ O-Z -/ 'r^ .,Q!/1C'�I//_ /912��'� <br />G CdA. ��/•'t <br />USE OF BUILDING HEAT SOURCE CON RACT PRICE OF WORK <br />0 <br />i1 /C - _ Electric —XGas _ Other <br />WORK DESCRIPTION <br />Allis ,u l 2x <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTU,IE OR ITEM <br />Toilet <br />A/C — air handling units <br />Bathtub <br />L <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />_� <br />Water heater <br />Kitchen sink 8 disposal <br />Gas fireplace <br />y_ <br />Dishwasher <br />Clothes washer <br />Gas range <br />Clothes dryer <br />Laundry tray <br />7 <br />Range hood <br />_ <br />Sink (servicelbar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow prevenler <br />Heal pump <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler I/ <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap Y <br />Woodslove <br />Roof drains <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />1 hereby coritify that I have read and examined this application and (now 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 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 fo, which application is made and I comply with the <br />State Contr Law 1 7 RCW and 208.200 WAC. <br />SlgFrature of Owner nl rWr/Authbond Agent Date <br />IV t.J.'31*,� <br />