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APPLICATION <br />PERMIT APPLICATION <br />eveq[n vEAmrt s[nvic[s <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 8 AM TO 4 PM <br />SITE ADDRESS evt:+�.'�t wn PARCEL TAX I.C. # <br />PERMIT # <br />(o-'OS tiVF.�L�12E�ti" W ct $ZD) u v 3 JOoo�O jw <br />�L�L <br />LEGAL LOT NO. BLOCK <br />TRACTOR SUBDIVISION N <br />DESC. <br />OWNER ADDRESS CITYIZh' PHONE <br />+.s/ox r a.P! <br />$�iuc�t5/[�rRCt I ly AvtoPwalS 630$ EVtc't/L6K.it+.) w+wrj f,�/au.aT•►- 5.a2o3 <br />TENANT NAME <br />CONTACT P/ERtAIT PHONE caOZ- b31 - jjry <br />r <br />sdl�n,. <br />[//1 ,y <br />SC�ut-ILS� G �.Ct II4 rj s <br />ry <br />�FOR <br />R <br />m.w <br />/�yrJ j/A'Y <br />1 <br />7 rr(V EMAIL <br />CONTRACTOR �.r..b�'_.., <br />ADDRESS CI IZIP PHOr1E <br />CONTR. LICENSE # EUG 0421 So2ZoT Zlw PP'cttLC- F4V6 EVryiattt <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />�CC>a+l(— <br />,Electric _ Gas _Other <br />WORK DESCRIPTION <br />lZEP/AU Ail �OC✓N�- SuPp/�c�� ! fl elf iZ%rJ <br />PLUMBING <br />MECHANICAL <br />NO, TYPE OF FIXTURE OR ITEM <br />N0. TYPE OF FIXTURE OR ITEM <br />— _ <br />Toilet <br />� <br />A/C —air handling units <br />— <br />Bathtub <br />Forced air systems <br />____ <br />Lavatory (wash basin) <br />_Gas <br />piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />_Clothes <br />dryer <br />_ <br />Water heater <br />Range hood <br />Sink (s^rvica/bar/mop/etc.) <br />Exhaust tart <br />Backllow preventor <br />Heat pump <br />Unit heater <br />_Urinal <br />Drinking Fountain <br />Boller <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Groaee trap <br />Woodstovo <br />_ <br />Rooi drains <br />Other <br />Other <br />CITY OF C-VERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of lases and <br />ordinaces governing this type of work will be complied 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 any other state or local law regulating 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 />Statetractors Law 18.27 RCW and 290200 WAC. <br />signature Of v+n d onlracter/Authorized;.gent Date <br />— I <br />PERMIT <br />