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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 B AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. p <br />AI ERMIT N <br />A3U 93 F4 S r. <br />3 1 �j�ck�IUd <br />�� <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION N <br />DESC. 0 <br />OWNER <br />ADDRESS CITYIZIP PHONE 4'Za) A4-.j <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE y- ZJ47 vo 1-7 <br />I (-olmeh Ii4_/Yr W4 E•MAIL14e9yC A 40ow-#%T.Ae7 <br />—Z1IYIZIP —PHONE <br />C-- — <br />pAwf,ou KA/kE /LeJ- 61AO,y4 SAC <br />78-190u !S ^r vµ, 5h.4CI.vc W.4 Ygi77 <br />CONTR. LICENSE 1r <br />/� <br />I 4L-)'761 Q e�3&'6 s <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />NL w !,/,+fi <br />Electric _ Gas __ Other <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEIS <br />NO. TYPE OF FIXTURE OR ITEM <br />3 <br />Toilet <br />_ <br />AdC - air handling units <br />BathlUb <br />_ I <br />FL :ed air systems <br />. <br />Laialory (wash basin) <br />Ges nIping <br />_L <br />Shower <br />I <br />Wale! neater <br />I <br />Kitchen sink & disposal <br />Gas firupiace <br />= <br />Dishwasher <br />Gas rtnlge <br />I <br />Clothes washer <br />I <br />Clothes dryer <br />.�_ <br />Water heater <br />1 <br />R: nge hood <br />Sink (servicefbarlmop/etc.) <br />S-- <br />Exhaust tan <br />Backflow preventer <br />Heat pump <br />�� <br />Urinal <br />// <br />Unit heater [! <br />_ <br />_ <br />Drinking Fountain <br />Boller <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />Root drains <br />Other- _ <br />_ <br />Other <br />4 7 9- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby cedtify that I have read and examined this <br />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 <br />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 <br />any other slate or local law regu'aling 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 Contractors Law 18.27 RCW and 298.200 WAC. <br />rtt�. �Cn1k� <br />► �1 <br />8igrfaluro OVOwnerlConlractortAuthorized Agent <br />_ <br />o Date <br />� <br />n <br />