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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 - vww.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7 <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />C,0i _ o t Ave. ) 11300(DC)01D1 Flom.-LL <br />LEGAL LOT NO. BLOCK TRACT <br />DESC ( mr� U-D1 CLIMAX LAND C.O. 1ST ADD TaEvcRt"R"6 <br />OWNER ?0, 1r%DX02)U HUwn�O. ­.. ...- <br />TP_ Evert- QiY11C,- Lab 3'101 4% t 1\ve. Evtrel 95 a= (425)258-39D0 <br />TENANT NAME �nj'q�,'}:'ljQYl COX 1� CONTACT FOR PERMIT PHONE <br />-IhP-_Eve _ Vlic �Ug(14'� ��ores (253) 38-9_780 <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />Aubur n Mechontcaa P.D. Auburn (a53) 938-01780 <br />CONTR. LICENSE# k\, &\ RJAT I 3gA 99011 _ <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />Nt <br />ted(Ca1 Center Electric _ Gas _Other <br />WORK DESCRIPTION D <br />Ing�pl�ption O� 1 s1YTk \ �\oor �r0.\T\1 1 Emergency S'nower3 (� <br />Gm55\7'b� S"Fa�tHYl <br />NO. I TYPE OF FIXTURE OR ITEM <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundryg tray <br />Sink (service/bar/mop/etc.) <br />Backflow pre'venter <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains ���� �(�.{-��..LL <br />Other Sj,hSsl% %Oy\ <br />__ <br />— <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas (replace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />_ <br />_ <br />_ <br />_ <br />_ <br />— <br />= <br />_ <br />_ <br />_ <br />_ <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 />ordinates governing this type of work will be :omplied 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 regu!ating 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 18.27 RCW and 296.200 WAC. <br />