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P�RMIT APPLlCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CGDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# ,PERMIT# <br /> 130� l�.na A� DOUSo � � � � �� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> GK F�n�srPK �pL-3/o/-S/4y <br /> �T�'✓E /�cFA2[_A�/E /�7�`/ �S.�.Aue NE 9g/55 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> T�r�Y D�{wso,�l f3rzr,a,� �ro c�� y Zs-��s�yG�' <br /> E•MAIL <br /> CONTRACTOR AODRESS CITY/ZIP PHONE <br /> DAy�-n��iE OcmQU d- NTCr. l�/� /3� Avr,u>. � s����v�� ti�zs-���yby <br /> CONTR. LICENSE# ��J37 <br /> D,qy�s'o�t9yN�q — <br /> USE OF BUILDING HEA-SOURCE CONTRACT PRICE OF WORK <br /> _Eleciric �Gas_Other � �� /�' � <br /> WORK DESCRIPTION <br /> 2EPcgcE �x�s�NG- �5 �u/�,vA-�E u�„�t-f N e�cJ Gf}-5 <br /> � Fu2��-e� ,� 5arn� Lo�"'on! . <br /> ; _ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITFM <br /> Toilel A/C—air handling unils <br /> Balhtub � Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Water healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasranc�e <br /> Clothes washer _ Cloth:s dryer <br /> Water healer _ Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust(an <br /> Back(low preventer _ Heat�ump <br /> Urinal _ Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeretion <br /> Grease lrep _ Woodstove <br /> Roof drains _ Other <br /> Olher — <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y thal I have read and examined this application and know ihe same to be true and correcl P.II provisions of laws and <br /> ordinaces governing this lype of work will be complied wilh whether speci(ied herein or noL The granting o(a permil does not presume <br /> lo give authoriry to violate or cancel lhe provision of any other state or local law regulating conslruction or the performance of <br /> construclion.Thal I am aulhorized by the owner of this property to perform lhe work for which applicalion is made and I comply wilh lhe <br /> Slale Coa aclors Law 18. RC and �.200 WAC. <br /> 11/�i_��7 <br /> Signalure OwnedContractod th eSAc�enl Date <br />