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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.evereUwa.otg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. R <br />PERMIT • <br />C fe - 00 <br />LEG LOI NO. BLOCK TRACTOR SUBDIVISION/ _ \ <br />ESC. Q f�� C�✓+ (,r i4 �r <br />�,lC 1 <br />;(t�IAr'It Ae, <br />OWNER AVORESS PHONE <br />-. �L1 '01 V Q�ilncla-'�, wlle'x I t r'/e�ff q?'21ty L(IS 2t? 22tO <br />r ,'Ir., /l LA _ <br />TENANT NAME <br />CONTAC r FOR PERMIT PHONE LI ZS Z r t 41} IL' F 2,07 <br />I'. li,i .t;i,t i,g JCIYMQ✓ E#IAIL `, . u l�,l„g< C•' rYnrwt iLO• <br />caRrl CTaf1-,'I , I.•• c. t t,.,, 1.• AVyU11t:55 PHONE <br />�� Avt. NtJ R -9sr'3 <br />CONTit. LICENSE Ir i <br />l'.I. _(� �I�,l.•Yl, ��dht�tnC r(S,II 1 <br />USE OF BUILDING <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />{.ti,t Iz. M��I �t't�tc 11lel itnlU <br />I <br />` <br />— Electric Gas _Other <br />P. 1. I frrT r <br />WORK DESCRIPTION <br />i <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR II FM <br />Toilet <br />A/C — air handling units <br />Bathtub <br />T <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />= <br />Water heater <br />1 <br />Kitchen sink d disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />washer <br />=' <br />Clothes dryer <br />4Clothes <br />— <br />Water heater <br />Range hood <br />Sink (servicelbar/mop/otc.) <br />Exhaust fen <br />Backgow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boller <br />Floor dntin <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify 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 wig be compiled with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate at cancel the provision of any other state or local law regulating construction or the performance of <br />tlorlstnleSon. 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 />`13' a Contractors Law 18.27 RCW and 296.200 WAC <br />sognature er tradtX W rizAgent ale <br />tlrl <br />