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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA QS201 <br />425-257-8810 —FAX 425-257-8857 — www.everel;wa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # ERMIT # , <br />l - col <br />c i (,f 0� <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />RESS CITYIZIP PHONE <br />OWNER ADDES <br />n <br />It f y 4 1 �i/11G 7 l CQZU/ <br />TENANT CONTACT FO `PERMIT �1c PHONE {� <br />I I�d1�O <br />Il()f1�wickerCITYIZIP <br />�NAME <br />I_ <br />rA r' I ( <br />�ADDREsn <br />� PHONE <br />CONTRACT <br />5t�'111.4 _117e NgemS) Inc • IIOl9-SLIFh A/c E TComCZ`8Y2_1(z5 )UP -WO <br />CONTR. LICENSE # <br />5mr�� As/3&o-r <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />/ � _Other `W 3/Jj00, <br />_Electric _Gas <br />( Omme"'L /id <br />r <br />WORK DESCRIPTION Smi+h rl(e Systems wul modffl( }l,vL exls+insue+ -pipe -fire. <br />pmkt A%A N&Wm -fib ai.cokkW4Vv- newcmm odrp C61,krt S. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />_ <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />_ <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />BackBaw preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />_ <br />Unit heater <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />_ <br />Woodstove <br />_ <br />Roof drains <br />_ <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 310S <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 Contractors Law 18.27 RCW and 296.200 WAC. <br />51 At-1 61 l 2yk <br />Signature of Owner/ ontractor/Authonzed Agent Liale <br />