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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.'I PERMIT It <br />I CM01-0NO <br />93 PA -S <br />Ci2366061Lo3 <br />0 <br />LEGALt LOT N0. <br />BLOCK <br />TRACT OR SUBDIVISION R <br />DESC. <br />11i.���/ (-C-'W- <br />OWNER ADDRESS CITYIZIP PHONE <br />i1n1.1nE�i-p_Ca 1 L c ?nW Vr I�'4 "ao f✓IlcH `�b Z+► NzS �5a 4 X 3 <br />TENANT NAME CONTACT FOR P RMIT PHONE !y- Z39 - 410-7 <br />I f-MM e7 — ",v E-MAIL AAtlt45oy5 a [w«e•�c7 <br />^ 5tv77 <br />ZOATRA7STaR /dA YYSuN �(.1 wiz Rai GAwpSnrc. 11F'ryJ S i/YO NW A- a:b �/r�B C4.vE �' <br />CONTR. LICENSE 0 /� A vV S 0 k R 913 U 4 5— <br />USE OF BUILDINGU HEAT SOURCE CONTRACT PRICE OF WORK <br />AA <br />60MI IC 6i1MI y/ CAN NO <br />Elerldc 361 q 3 `% <br />I <br />_Gas _Other � <br />WORK DESCRIPTION <br />',VEw Noble 12g2 <br />:�2 Ci ') <br />Sic <br />,%b _ .3 <br />J <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />Toile) <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 & disposal <br />_ <br />Gas fireplace <br />_J_ <br />Dishwasher <br />Gas range <br />Clothes washer <br />I <br />Clothes dryer <br />Water healer <br />_J_ <br />Range hood <br />Sln� Nervicelbarlmop/etc.) <br />1�_ <br />Exhaust fan <br />Backflow Preventer <br />_ <br />Hest pump <br />Urinal <br />_ <br />Un8 healer <br />_ <br />Drinking Fountain <br />Boller <br />Floor drain <br />_ff_ <br />Refrigeration <br />Grease trap <br />Woodslove <br />�- <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify that 1 have read and examined this application and know the some to be true and correct. All provisions o1 laws and <br />ordinaces governing this type of work will be compiled 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 />Slate Co tractors Law 18.27 and 296.200 WAC. <br />1 <br />Slgneture o Owner/ ontractodAuthorwed Agent Dal [ 2- <br />h. C aOXe - ffkn44Z✓-- <br />