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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES i <br /> 3200 CEDAR STREET, EVERE fT, 1A�A �J8201 <br /> 425-257-8810— FAX 425-257-8857- www.everettwa.org <br /> ,j 7�z APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PE IT# <br /> � �roa�ura �� �43734Z.SG�G1 ���1`�'C'/�� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ` �f �luay uY'ev GLG, 21/7,�c�feJ%r r�e �ve,r��f �C9zs)z�a-z� <br /> TENANTNAME � CONTACTFORPERMIT T— PHONE <br /> Sfe��e /�a��es �z��6�Z -sa�o <br /> CONTRACTORO� �,y �G eHE4L�/(..�NYIR(�DDRESS �� CINI2IP PHONE <br /> Y � �a �y�7e2 �feu�i��9ve, Evo�e�f �gz�) �l�-DP�i <br /> CONTR.LICENSEI dLyMP�G q75PZ <br /> USE�/OF BUI/L�DING/) HEAT SOURCE y�CONTFACT PRICE OF WORK <br /> �t7,Li� (-�u�`Ofk y _Electric�yGas_Other "1 �J'r�w� <br /> WORK DESCRIFTION <br /> New l�elarl S�ell�3�s�1�%/�9' <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIxTURE OR ITEM <br /> Toilet A/C–air handling units <br /> E3atMub Forced air systems <br /> Lavalory(wash basin) _ Gas piping � <br /> Shower _ Water heater � <br /> Kitchen sink 8 disposal _ Gas freplace .,A <br /> Dishwasher _ Gas range �n !��� <br /> Clothes washer _ Clothes dryer �f�llC�iV <br /> _ Laundry tray _ Range hood ���� �� <br /> Sink(servicelbar/mop/etc.) _ Exhaust fan <br /> _ Backllow preventer _ Heat pump �' <br /> Unnal _ Unit heater � �(`�u <br /> _ Drinkir,g Fountain _ Boiler � <br /> Floor drain Refrigeration <br /> Grer :e trap _ Woodstove <br /> Rooldrains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> I hereby ceritity Ihat I have read and examined this application and know the same to be true znd correcL All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specifed herein or not.The granting of a pertnit does not presume <br /> to give aulhonty to violate or cancel the provision of any other slale or local law regulating construction or the pericrtnance of <br /> wnsWdion.Thal I am authorized by Ihe owner of this property to pedorm Ihe work for whlch application is made and I comply with the <br /> State Contractors Law 18 j7 RCW and 296200 WAC. <br /> ��/('�-2, EJ�G��.��, C�Z � <br /> Sigi2ture of OwnedContrador/Authonzetl Agent ` ° ate �/ <br /> r� <br />