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PERMIT APPLICATION /ca�oca-cA 0 <br />CITY OF EVERETT (PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 1 --7 �9-0 <br />425-257-8810 — FAX 425-2F 7-8857 — www.everetlwa.org Oft <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. 8 RMrT <br />LEOAI LOTNt:1, BLOCK TRACT ORSURDIVMM0 <br />(Y, LkJ1r,4ri l -si-e Ca.nrLe, ('(L✓� l'crYb <br />PHONE <br />OWN -- 2/� <br />l ('itr(le., Cvu 1 L-L -2)1C) <br />7 V 'yevdt.,lru i' i(''X,1 CJP/PHg" L(IS 117 21W <br />TENANT NAME I CONTACT FOR PERMIT PHONE rl C',7 St L I�j to y 2AS <br />)6LL(;VV4IL `C11 ' EMAIL .k.va•,gfG'r1C:Tuf3hLr• tyrt <br />Ik��Ud r' I.dnr Iby;(• Ccrha�bt nfl <br />� AvC. NvJ A •� 3 <br />COMM, LICENSE( <br />USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br />Itcrry- Electric Gas Other --- <br />WORK DESCRIPTION <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTUr.E OR ITEM No. TYPE OF FIXTURE OR ITEM <br />_ Toilet A/C - air handling units <br />_ Bathtub I Forced air systems <br />Lavatory (wash basin) Gas piping <br />(� Shower = Water heater <br />Kitchen sink 8 dit posal Gas fireplace <br />Dishwasher Gas range <br />Clothes washer T Clothes dryer <br />L Water heater Range hood <br />Sink (service(bar/mop/etc.) 1 Exhaust Ian <br />HackBow preventer _ Heat pump <br />Urinal _ Unit healer <br />Drinking Fountain Boiler <br />Floor drain Refrigeration <br />_ Grease trap _ Woodslove <br />Rooldrains Other_ _ <br />Other _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify 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 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 the work for which application is made and I comply with the <br />Stale Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of Livirner/t.;ontraelor/Aillnerizedgent a I Z <br />i3 18-4 <br />