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PERMIT APPLICATIOnI <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAf. STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM tf AM TO 4 PM 9� (� '�D� <br /> SITE ADDRESS PARCEL 7AX I.D.# PERMIT# <br /> �U.30 L'-V�G�EC-� � �' 7�7Cf -? <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER D� r/�p �'�'� ADDRESS CITY2IP PHONE <br /> �"�� �'.�l✓ES�nne�vT �ol�P. 1�30! G�L'�'iz-*� u''y 9i�� e�� �[z5-35'�312Z <br /> TENANTNAME CONTACTFO PERMIT PHONE <br /> ,�,,J y25�775'�0��� <br /> 8�`�^�" CU � E•MAIL <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> DkY d-�iTE /'�r�eU d�NT(- /(Gl�l (3.� �4'►�e_!,:) . L�i�/�woo1J �25-7�s"-(o�!(o�� <br /> CONTR.LICENSE#����PNO��C� 9�,j? <br /> USE OF BUILDING I — H�AT SOURCE CONTRACT PRICE OF WORK <br /> Electric �Gas_Olher � ���' G� <br /> WORK DESCRIPTION , <br /> I �P�ic�e �.x�sn..r(r ,5 TD� �s G:4cr�- �'�r �P <br /> cc�iT w��� n�eu� � ;ar� �s P� 2�= 7�� <br /> i G[n//%� �J SAfrl� LoC.�T10� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Balhlub Forced air syslems <br /> Lavalory(v�ash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink& disposal _ Gas fireplace <br /> Dishwasher Gas renge <br /> Clothes washer Clolhes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mop/etc.) _ [xhaust fan <br /> Backflo�v prevenler _ Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> Roof drains � O�lh'e"r 7�GN G/FS 0 •k <br /> Other _ Lcr.�F 7'a G!N!T'. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined lhis application and know the same to be true and correcL All provisions of Iaws and <br /> ordinaces governing this rype of work will be complied with whelher speci(ied herein or not The granting of a permit does nol presume <br /> lo give authorily to violate or cancel the provision of any other state or local law regu�ating conslruction or the performance of <br /> conslruction.Thal I am authorized by lhe owner of this property lo perform the work for which applicalion is made and I comply with the <br /> Stale C9n)rectors Law 18�7 F�;W and 200 WAC. <br /> � ..� ��/d n 9-`,�/'��-�/ <br /> Signatur f OwnedConlractor/ _e �t-- Dale <br />