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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.eve ettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />531 <br />) ' -& ; <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION# <br />DESC. <br />OWNER ADDRESS CITY2IP PHONE <br />VEM <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE ,.��73 -47/ - 7960 <br />{" <br />(/� �:laG'�iC/✓ME7(/` % ry�i� km(oj <br />KLIiFI P^,zz i fth.: /1 r��ti:� E-MAIL J/%f(�'F[n •. <br />Zc6NTfiACTADDRESS CITYIZIP <br />ILA(, ING l_LC- 2t06 36WSrRW '7Akcuart 011 <br />CONTR. LICENSE# - <br />Fuac; > FL ¢3 i�S-re `J^ P Yflv`r <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />yr :c <br />-L 3 (�3(3.:— <br />Electric _Gas _Other <br />WORK DESCRIPTION �Q' f�ji).A2J) STj/LE JfL.vnrnu inl <br />.ion 'nrf 71tAF%56 of r4-Y'AA%- A .5X8 tl S cc" ANO A -fA'G t'e r yl t t 4 012 <br />(.(JAsHrn�yrac.r sAf^' ��r" IrALuc tlOt 3ic;30 <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 />Lavatory (wash basin) <br />_ <br />Forced air systems <br />Gas piping <br />Shower <br />Water heater <br />Kitchen sink & disposal <br />Gas fireplace Q� <br />=Dishwasher <br />Clothes washer <br />Gas range ij <br />Clothes dryer 2 IZ <br />,J <br />_ <br />Water heater <br />_ _ <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow preventer <br />_ <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />Grease trap <br />_ _ <br />Woodstove <br />_ <br />Roof drains <br />Other <br />Other <br />CITY 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 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 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 />Stale ContractorsLawLaw 18.27 RCW and 296.200 WAC. <br />� L (rs <br />t eetl" L 1e0� <br />Signa re of Owner/Contractor/Authorized Agent Date i <br />/z <br />