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PL��MIT APPLICATIG�J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, E�'ERETT, WA 98201 <br /> 425-257-8910 — FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DE:81T 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# Y'�/�R S�I � � <br /> d.7�� k�• - <br /> LEGA LOTNO. BLOCK TRACT <br /> DE�C. <br /> OWNER A�DRESS CITV2IP PHONE <br /> /� p 70FS 1jo k•r E J<x� S�;Jn( /�5-a-Sd- s�vti 3 <br /> ,(jerric. UfL�4�en �` <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> < (�err�., 8/z.a"��n 4��-)�3-J`Y53 <br /> Jan�• n� r.171/< — <br /> CONTRA�TOR S�n�d� ��r•-^��'• ADDRE55 �J,�y ��y'y' �� ��TY21P PHONE <br /> oE s�� c� >�� o �ia� �c�.a�.�.- <br /> CONTR.LICENSEN _ /�/I µ�C��IIfO , Llff� %b�7� <br /> Sp� ,< <l O <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � ���. � �y rts,�lr,,<< Electnc _Gas�Other <br /> WORKDESCRIPTION ��t�`�fr _��� ��I���� �r.}�. ��:.,�r� <br /> I'LUMBING MECHANICAL. <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ A/C–air handling unita <br /> Bathtub _ Forced alr syslems <br /> Lavalory(wash hasin) _ Gas F aing <br /> Shewer X Water hE aler <br /> Kitchen sink 8 disposal _ Gas 1lreplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Ciothea dryer <br /> Laundry trey _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backilow preventer _ Heat pump <br /> � Unnal _ UNt heater <br /> � Drinking Founlain _ Boiler <br /> i Floor drain — <br /> ReirigeraUon <br /> i _ Greasetrap _ �W�esrove <br /> i _ Roof drains — <br /> Other_ <br /> I CITY OF EVERETT LOCAL SALES TN(CODE IS 7105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provislons of lews and <br /> ordinaces goveming lhis type of work will be complied wilh whether specified herein or not.The grenling of a permit doea not presume <br /> to grve authonty to vlolate or cancel lhe pruvision of any othar state or local law regulating constructlon or lhe perfortnance of <br /> I construction. That I am authorized by the owner of Rtis property to perform the work for which application is made and I comply with the <br /> Slate Contracto/rs Law 1�7 RC and 296.200 WAC. <br /> I �d� �i/ J��DG�Oti — <br /> � SignaW � ner�ContracrovAu�ho7¢ed Agent afe <br />