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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREE"I f-VERETT, WA 98201 <br />425.257.8810 — FAX 425-25 , 8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. N <br />RMR R <br />i <br />I <br />LEGA LOT No. <br />BLOCK <br />TRACT OR SUBDIVISION 0 <br />DESC. i <br />(" am4r Le Cctr' Ctr ru <br />;! 1.'�. 1.. .' \ <br />OWNER <br />ADDRESS <br />CvreflgElzLN% Lj1S 117 zttk) <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE L125151. t 11X i0 X 30,' <br />I <br />"r .i.3 �rGi CNf✓ E4AIL�xurSL.niC'rYnwt�4i�. <br />CONTRACTOR ,A1f6RE98EXTYroap— <br />.41 till e la r � .n•�+,CFI <br />CONTR. LICENSE 0 t _ <br />USE OF BUILDING <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />. . <br />Electric Gas Other <br />—..- -- - - I <br />It,r. <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NCI. TYPE OF FIXTURE <br />On ITEM <br />NO. TYPE OF FIXTU9E OR REM <br />' <br />Toilet <br />A/C - air handling units <br />Bathtub <br />_ <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />149_ <br />Shower <br />Water heater <br />Kitchen sink 6 disposal <br />Gas fireplace <br />__ <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />�. <br />Water heater <br />Range hood <br />Sink (service/bar/mop/atc) <br />Exhaust fan <br />Backnowpreventer <br />Heat pump <br />_ <br />Urinal <br />Unit healer <br />Drinking Fountain <br />Boiler <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CRY OF EVERETT LOCAL SALES TAX CODE 18 P106 <br />I hereby ceritily 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 vdth whether specified herein or not. The granting of a pemrit does nol 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 pmperty to perform the work for which application is made and I comply with the <br />State'Contractors Law 18.27 RCW and 296.200 �1AC. <br />t <br />grgnaNre oiOWTer ontrador ut z ant Date ' <br />