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�I-" 10 <br />FRMIT 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 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />3003 W, CIA SIrvo 2D <br />I <br />j3p�2-a►c1 <br />LEGA LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />13 <br />OWNER ADDRESS CITY/ZIP PHONE <br />QoEIN4 <br />TENANT NAME <br />CONTACT FOR PERMIT P N <br />i4 l� 92 <br />goo146 <br />NUK( 145l3'"'M <br />E-Ma L <br />L <br />dM �pni,rfluCONTRACTOR ADDRESS CITYIZIP PHONE <br />GT10 ,� <br />r <br />CONTR. LICENSE # <br />USE OF BUILDING HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I <br />M F G • 1 — Electric _ Gas _ Other <br />'o b t 000 <br />I <br />WORK DESCRIPTION <br />(l P4n-�a-,�6 /LE3i2oowl <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />Sink (servico/bar/mop/etc.) <br />_ <br />_ <br />Exhaust fan <br />_ <br />Backgow prevenler <br />Heal pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodslove <br />_ <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 application and know the same to be true and correct. All provisions of laws and <br />ordinac:es 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 stale 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 />State Contractors Law 18. 7 RCW a 2£6.200 WAC. <br />s4 (� i rh-l✓ - /Z/2 /07 <br />Signature of Owner/Contractor/Authorized Agent Date 1 X <br />