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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR 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.# ERMIT# <br /> 1022 GYa,hd o0385�2� 00500 � ��s-i� <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. FRA,G '�'j� (o�� 217'f <br /> OWNER ADDRESS CITY2IP PHONE QZs <br /> Tim �e.isev�c�,uP�✓ �022 G✓'�.,,,c� �1�., Evere�' �182� 1 6ib� <br /> TENANT NAME CONTACT FOR PERMIT A PHONE <br /> pvJnl�1=- �obe,�l� �-�c�.r, /".rr�,��ec�' Zo6 'jo6 5'i4� <br /> CON73ACTOR ��L- -- ��-�' - ` �A ! ' CITY2IP PHONE <br /> J,l�h o o�sol�ca. i826 2��.�ev�,�e., Eve✓ett' qe2o1 A�25 -232- ► 482 <br /> CONTR.LICENS u �f�o�,.aL o���� � <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> Q,e5 j�e,v�G� _Eleclric �Gas_Other `—`����� <br /> WORK DESCRIPATION (` (� I� f� <br /> A�� �T� 5.1'• -YD✓ Y12w bQ.se•-r• eI �nT �n.ir, l�Cv�-�0 ��5� C�Gi�iHq <br /> S-�i✓- a.hd re- -F.-�.,,.e ��oor STYJc�-v ✓e `� <br /> PLUMBING MECHAP�ICAL. <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURG OR ITEM <br /> Toilel A/C-air handling units <br /> Bathlub Porced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwashcr Gas range <br /> Clothes washer Clolhes dryer <br /> Water healer Range hood <br /> Sink (serviceNar/moplelc.) _ Exhaust fan <br /> Backllow preventer _ Heat pump <br /> Urinal Unil hea�er <br /> Drinking Founlain _ Boiier <br /> Floor drain Refrigeration <br /> Grease trap _ lNoodslove <br /> � Roof drains _ Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify lhal I have read and examined this application and know the same to be lrue and correcl. All provisions of laws and <br /> ordinaces goveminc�this lype o(work will be complied with wBethe: specified herein or not.The granting ot a permil does nol presume <br /> lo give aulhority to violale or cancel the provision o(any olher stale or locai law regulating construction or lhe pedormance of <br /> conslruction.Thal I am aulhorized by the owner o(this properly to perform lhe work for which application is made and I comply with the <br /> Slate Co [ clors Law 18.27 RCW and 296.200 WAC. <br /> �.�-�� CJ- �'(-c G.- <br /> Signaluro of C�r7iedContra lorlAulhorized Agent Date � ` <br /> �JorlN !-lj�:�L�:'�'L't iL <br />