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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 982.01 <br />425-257-8810 — FAX 425.257-E857 — www.everettwa.Drg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. 0 Cr�Al j/ 'L C1ZLU <br />P RMIT S <br />9'lol -oot'i-11ve • <br />LEGALL LOT NO. <br />DESC. •[''till[ �7'��i <br />BLOCK <br />- <br />n TRACTOR SUBDIVISION 0 <br />L )1 ()1i.I X �G1f L'I �IJ?91�(Y)� S I '�Pt(�U�L/ h�1i'�. <br />OWNER ADDRESS CITY/ZIP PHONE <br />`file �/e-Q,4 ft nj(:. ?f'(ol 00j-1 e �420 `��`tI72jo <br />TENANT NAME ,1 / <br />�nI /�e�etf <br />vl`y <br />O�{�ITACT FOR PERMIT PHONEG�I �.7J, 7, LI Z,0 <br />��C(7/)lLlai7'y^>7Q�1 <br />`ilk <br />l' LI/lI� <br />I <br />�uf',flt1(1�i111C- EdAAIL�4Vt7Crll�Pe((a(?ttC)IO, <br />CONTRACTOR ADDRESS CITr/ZIP PHONE <br />-n'V.,fvP,^_e�,l vliniC, �fI01 1 10. s�h/Q. t 2nV�kf W <br />CONTR. LICENSE 0 �. C iz G D1 / <br />.` <br />USE O,F, BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />,( <br />I Uimi C 0.l', G4(n IG <br />_ Electric _ Gas __ Other <br />bo ow <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />_ <br />A/C— air handling units <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water healer <br />_ <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />washer <br />_ <br />Clothes dryer <br />_Clothes <br />_ <br />Water heater <br />_ <br />Range hood <br />_ <br />Sink (service/barlmop/etc.) <br />Exhaust fan <br />_ <br />BackBow preventor <br />Heat pump <br />_ <br />Urinal <br />Unit, heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />Grease trap <br />Roof drains . `/I1_ <br />Woodstove <br />Other <br />Other 1v ii""TT <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 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 />ordinances 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 />State Contractors Law 18.27 RCW and 296 200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />&M <br />