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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 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. 0 <br />RMR t <br />1y w!< <;Lv <br />(%•'Yid--7 Ri lC�� <br />I ��Cssssss��gJ: <br />LEGAQ LOT NO. <br />BLOCK <br />TP.ACT OR SUBDIVISION / ^ 11\ <br />'. CCL✓'f- ('Cn[Iu J <br />DESC. <br />(`(., Ii i :. 1, . Ia).E'i ( `a,l{y� <br />OWNER [[��p ----C—rrYIMP PHONE <br />1 <br />C'un(1ier, Co6i L-1 �T11 (C "OndwM �ahk'xl [ •,;.i+ �jf 2r1 Lj15 l Ij 2z10 <br />TENANT NAME <br />CONTACT FOR PERIIIIT PHONE i17S, I S1.- kt'7} ILI x ;1J2 <br />I <br />)L46t%-I4 `a"(W✓ E-MAIL `• .,II•:l n[C !YetL� <br />CONTRACTOR Llab�4.. '-...;. R<L C,.ifrrnA13DREM <br />IGtrPIXy`.( Cant.�1 nFl <br />4([00 '-�Awc, wl�J A-S 3 <br />CONTR. LICENSE <br />USE OF BUII DING HEAT SOURCE I CONTRACT PRICE OF WORK <br />` ArY'11ll �l/liI-I (�['I.aIV[f([M.l(I <br />t-kn>r- _Electric Gas _Other <br />WORK DESCRIPTION <br />I �. lt1.+�'f lL1 `.i r •i_ I, G'1- ').'� , y,,i1 :1 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />Bathtub <br />� <br />Forced air systems <br />Lavatory (wash basin) <br />Shower__ <br />Gas piping <br />Water healer <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />Clothes washer <br />_ <br />lass range <br />Clothes dryer <br />Water heater <br />�_ <br />Range hood <br />Sink (servicelbar/mopratc.) <br />1# <br />Exhaust ten <br />Backllow, preventer <br />Heat pump <br />Urinal <br />__ <br />Unit healer <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Flour drain <br />Refrigeration <br />_ <br />Grease trap <br />I'loodslove <br />Roof drains <br />0I1er <br />CI1Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerltify that I have read and examined this application and know the same to be true and correct. All provi[;ions 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 no: presume <br />to give authority to violate or cancel the proA ision of any other state or local law regulating (bnstruction 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 />State Contractors Law 18.27 RCW and 2%.2W WAG ` <br />ig ern) o er ontractorl ut tonzze Agent l <br />I.I <br />VM <br />13 -?tr -9 <br />