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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 ACCEP FED FROM 8 AM TO 4 PM d - q . 07 <br />SITE ADDRESS <br />PARCEL 1AX I.D. x <br />PERMIT p <br />rj'�OlHo-ITr� <br />4 1 13oo U O Q I o <br />LEGAL LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION X <br />DESC. 1-9 c G%-Z <br />006 D-ol <br />if—w-hr, LAt10 Co. 15i Avw-llo _ <br />OWNER ADDRESS CITYrLIP PHONE <br />THe Ey g -TT GL-It1t� 39M }{0`j puG q�201 AZ5.339.5460 <br />11MANT NAME CONTACT FOR PERMIT PHON� _17_C 3Z7, 4726 <br />TF}E 1 tETLE iT Ct 1Mc l�o Nl1 MOH O}tG E-MAIL <br />CONTRACTOR ADDRESS CITYIZIP 'PHONE: <br />Tice F`s kKLl i G<a rtiC <br />CON! L LICENSE N <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />_—Electric Gas. Other <br />60t ooG °- F5'7. <br />PATIAol l_A$ <br />WORK DESCRIPTION /\ \ <br />F. e✓IoY w}1lo✓15 A'xd �11 �"Cl q�lohs I�clJd lnol P•rTi}�o�1S q'�l d� Mino/- .$-��.x.'�T�fa` <br />MJJ4t(4}te'tj/ r"1°:lt{ito-FlohJ 'W CKt>}1n, cnt-,' v:tia" 5°x"c v1Cw CC1tt^J q�n It�4}Iti�. <br />I)oA4tit.�io f off- 4i(c IfF( lu4e -1nA 4tc S tejJton 5]yFi tS. 6 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />NC— air handling units <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />Kitchen sink 8 disposal <br />— <br />Gas fireplace <br />ishwasher <br />___ <br />Gas range <br />olhes washer <br />_ <br />Clothes dryer <br />W ter heater <br />Range hood <br />_ <br />Sin (service/bar/mop/etc.) <br />Exhaust fan <br />Back ow preventer <br />Heat pump <br />Urinal <br />___ <br />Unit heater <br />Drinkin Fountain <br />_ <br />Boiler <br />Floor dra <br />___ <br />Refrigeration <br />Grease lra <br />_._ <br />Woodstove <br />_ <br />Ron:' drains <br />__ <br />Other <br />_ <br />_ % <br />Other_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />oldinaces 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 tho prevision of zny other state or local law regulating conshuction or the performance of <br />construction. That I am authorized by the owner of th.s property to perform the work for which application is made and I comply, with the <br />Stale Contractors Law 18.2ZfQX an 9 .200 WAC. <br />7 <br />Signature Of Owner Contractor/Authorized Agent D to / <br />�� L <br />I/ <br />