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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 8 AM TO 4 PM x(j lio (b -GU5 <br />SITE ADDRESS _ <br />"� �tnc <br />PARCEL TAX I.D. # <br />PERMI7 / <br />12• �' WE <br />LEGAL LOT NO. <br />BLOCK <br />TRACTOR SUBDIVISION p <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />•>c-iCI <br />`ft1CC.k12f_TrC���IC h���{�At/a /�i ZGr (qLS5y8 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />E-MAIL <br />CONTRACTOR ADDRESS I I <br />UN 111 Lg�IT) �•✓�'Ec`1IjN1CA L (/i! / / y`)� N 9G1,> <br />` 44q 16'2TSU 3lsy-`-j 1i/C <br />CONTR. LICENSE 11 <br />u�,0Nn <br />USE OF BUILDING <br />HEAT SOURCE PRICE OF WORK <br />L_t —/ �t _ „� <br />_ ` A ✓a _L..Li� � <br />,r�CONTRACT <br />�ctric �as _Other !?� � � S L �"-- <br />T c1 <br />WORK DESCRIPTION <br />IALL 2 �E <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C -air handling units <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />_ <br />Water healer <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust tan <br />2 <br />Backflow, preverder <br />_ <br />Heat pump <br />Urinal <br />Unit healer <br />_ <br />_ <br />Drinking Fountain <br />_2- <br />Boiler/y, _.qr,.., <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Gr^.asetrap <br />Wood stove <br />Roof drains <br />Other—,:'-wJ G. <br />outer ` A'r£12_3PtpINC- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerility that I have read and examined this application and know the sane to be true and cerrecl. All provisions of laws and <br />ordinates 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 viable or cancel the provision of any nthar stale or local law regulating consln.ction or the performance of <br />construction. That 1 am authorized by !lie owner of this property to perform the work for which application is made and I comply with the <br />Stale Contractors aw 18.2 CW an 98.200 WAC. <br />Signature of vne it c r Aull dz Agent Date <br />