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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.everelfwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />7 �'I I <br />PARCEL TAX I.D. R <br />, <br />PERMIT B <br />/. Q-60� <br />r� l -) <br />\ �� ' <br />LEGAILI <br />L9TINQ. <br />BLOCK <br />TRACTOR SUBDIVISION 0 <br />OESC. <br />l.1 1J7 <br />(Y\c-l�_'t`, " �. i..�e, Camrl.fv\ C,i ! CC elk) <br />OW PH E <br />L.l �_ 311 lat�ndk Sole 7..)L1 212 Z11W <br />r <br />TENANT NAME <br />CONTACT FOR PERW PHONE q?c,-j St cl sj IC R 1,L2 <br />I `tilirwil E-MAIL .itluAt C.'rti�tryif 3LP.� <br />�6NTiiAZTbA r �l1STSA CITV/Zip <br />4. ySI-(uTt.,b�.nft <br />CONTR. LICENSE X <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />In It i I � C�CI�a Iwrl (rnlp <br />I <br />I <br />— Electric Gas _ Other <br />WORK DESCRIPTION CY' � `^� C_-,tN 3�� y�l: <br />l <br />('�,1('t\ 1 -ttirw, , P�r C T' I � r-) 330 <br />PLUMBING <br />MECHANICAL <br />NO- TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTJRE OR ITEM <br />Toile) <br />A/C — air handling units <br />'T— <br />Bathtub <br />I <br />Forced air systems <br />b <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Z <br />Water healer <br />1 <br />Kitchen sink 8 disposal <br />Gas fireplace <br />' <br />Dishwasher <br />Gas range <br />i <br />Clothes washer <br />Clothes dryer <br />Water healer <br />ir <br />Range hood <br />Sink (servlcelbartmopletc.) <br />L4. <br />Exhaust fan <br />_ <br />Backflow preventer <br />He it pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />_ _ <br />Refrigeration <br />Grease trap <br />Woodslove <br />Roof drains <br />Other___ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify that I have read and examined this applicatian and know the se_me to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified hqreln of 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 regulubng 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 f comply with the <br />State Contractors Law 18.27 RCW and 296,200 WAC. <br />gighature of Owner/Con-t-ra-et-or7Au-tfi-oHzed Agent ale t <br />cWh <br />