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f <br />r <br />LEGA LOT NO. <br />BLOCK <br />TRACT OR 9UBOIVISIOf1 f <br />DESC. <br />((. 1� I Lit ,n(k•CY� (�(l+'A Cc1"CIJ ) <br />OWNER AUDRESS CITYrZIP <br />°ill a,I , lr'x 1 C JP/eH 9t;ary t{15 l It 2I10 <br />TENANT NAME CONTACT FOR PERMIT PHONE NZS15t y2y IQ 3c2 <br />I �LltCj�lrr'� V(t1,G6"f� E-MAIL ttSl.,griJckiTuf3W• <br />Itin. I1i454 (nTt..61 AF1 <br />1,&1'+e� s�RvG uH.l A->ju� <br />CONTR. LICENSE f <br />USE OF BUII.DINO <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />;1•Yl�i r'm, (•� e4 �I,,clvcl (rKrcr <br />I <br />I <br />J , <br />Electric _Other <br />h lt I�triV <br />— _Gas <br />WORK DESCRIPTION <br />� z <br />*+-rl' I))nE,r <br />PLUMBING <br />MECHANICAL <br />N0. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C -air handling units <br />�(— <br />Bathtub <br />—L <br />Forced air systems <br />•�j <br />1 jF— <br />Lavatory (wash basin) <br />Shower <br />= <br />Gas piping <br />Water heater <br />Kitchen sink 8 disposal <br />Gas fireplace <br />I <br />1 <br />Dishwasher <br />Clothes washer <br />=Clothes <br />Gas range <br />dryer <br />Water heater <br />Range hood <br />Sink (service/bar/mop/etc.) <br />� <br />Exhaust tan <br />Beckflow preventer <br />_Heal <br />pump <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />_Boller <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Wtwdstove <br />� <br />Root drains <br />_Other <br />_- <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE 19 3106 <br />I hereby ceritily 'hat I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates gavemirg this type of work will be complied with whether apecltied 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 />consppuuccgtTn. That 1 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 Lew 19.27 RCW and 286.200 WAC. <br />Signature o er nhedo�uthonzed Agerlt � 'eta 12- <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 -- FAX 425-257-8857 - wvnv.everetiwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. f <br />PERMIT <br />+r, <br />