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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.everettwii.org <br />APPLIf A71ONS ARE ACCEPTEU FROM B AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. f <br />PERMIT I <br />- <br />LEQA LOT NO. <br />- <br />BLOCK <br />TRACT OR BUBDIV1810N If <br />kl I <br />DESC. <br />Cn l.rj� r h•C I (,.Gr �t'= C a.v,CIfY1 C [ l✓� cc.'V <br />Oyy R C1TY21P H E <br />C'CQrnclitr C,VLI h L_i ��11 (� ei'[kFd I `v k' x I c .. • It `Ihir1 L(iS 117 2210 <br />TENANT NAME FOR PER11110 PHONE k.f Z51 St it7Y• K` x �,L2 <br />_CONTACT <br />i(,11, riLU r1E �,�Cil d4rF✓ E-MAIL , xr�1Sk• eCe! n�muf �.� <br />CONTRACTOR \Y.d �i. P i C,., p,.-ADuRawliV! <br />I[L,e lriy5@ CCrTv.6l,nf{ <br />CONTA. UCENSE I �\ A �.iU �- Q_ C i �1+• T•'f <is 11"1 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />hYtT �Gr11i� (ICIncIVrlCrnfd <br />I <br />I <br />4 , r <br />linu <br />— Electric —Gas _Other <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURF OFT ITFM <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C - air handling units <br />Bathtub <br />I <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />�1. <br />Shower <br />' _ <br />Water heater <br />Kitchen sink B disposal <br />Gas fireplace <br />Dishwasher <br />Clothes washer <br />= <br />Gas range <br />Clothes dryer <br />�. <br />Water heater <br />I <br />Range hood <br />Sink (service/bar/mop/etc.) <br />y <br />Exhaust fan <br />Backl ow preventer <br />Heat pump <br />_ <br />Unit healer <br />_Urinal <br />Fountain <br />Boiler <br />_Drinking <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />Root drains <br />Other <br />Other <br />CRY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws arid <br />ordinaces governing this type of work will be compiled with whether specified heroin 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 construelion or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which Wplication Is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature o er/ ontraclor ul nz Agent —Us a <br />l� <br />aY1T <br />