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� / <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��j��Z/�iJZ <br /> SITE ADDRESS PARCEL TAX I.D.� PE <br /> a�loy ��ne 5+-, oo i4 �-s �oa� •o� <br /> LEGA LOT N . a BLOCK <br /> DESC. Pt 3 L015031 �{' Q �'0� OD <br /> OWNER ADDRESS CITY/DP P110NE <br /> �c�nr �a-Fo�d/�e.rr�G-eury a�o� Pi ne5f �rev�.-� �aoi �ta5•33a- a 3s� <br /> ANtNAME ��!(' �jQAY(,. CONTACTFORPERMfT PMONE <br /> nh �.�� Dunn (�,r I �ann� GeaY� 4as• a3a- '�aia <br /> CONTRACTOR /� O�ne`/ ADDRESS CITVI�P PHONE <br /> J <br /> CONTR.LICENSE# <br /> USE OF BUILDING r e i n HEAT O CE n one� CONTRACT PRICE OF WORK <br /> ' 1 11ous� h 'c� J <br /> �� le -�[I'1r11� �'S I �ectric _Gas_Other � ��' � /�7� <br /> WORKDESCRIPTION has 0.l►^e.ctd� bee�n �an� etr "�_ �QYlS <br /> t�-2ilw�a� vr��-la�los b iw.be,✓l (� es . ' �op s v�e�r�d�j �. <br /> ��Ynusi'c R4orv�+� A,►r� e.urre,��y O�lu �ed � s�aC�� w i I�ca►�hn ur� �i�a Fx <br /> Newhavk � r +s of Rz/a s ma�' e *N�cci�� and � �"�a ��gbetf�lb �o . . <br /> � ' GI.0)t� si nc�. �(z <br /> PLUMBI G MECHANICAL <br /> NO. TYPE OF PIXTURE OR ITEM NO. TYPE OF FI%TURE OR tiEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> _ Clolhes washer Clothes dryer 1� ' <br /> _ Laundry tray _ Range hood �U{C.' <br /> _ Sink(service/bar/mop/etc.) Exhaust fan �� <br /> _ Backflow preventer _ Heat pump <br /> Unnal UnR heater � i <br /> _ Drinking Fountain Boiler �O <br /> _ Floordrain Refrigeretion '� <br /> _ Grease trap Woodstove � -�� � <br /> Roof drains Other �� ' <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br /> I hereby ceritify ihat I have read and examined this application and know the same to be true and corzect. All provisions of laws and <br /> o�dinaces governing this type of work will be complied with whether specified herein or not. The granting of a pertnit does not presume <br /> to give aulhority to violate or cancel the provision of any other state or local law regulating construdion or the performance of <br /> consl ion That I am aulhorized b �he owner of this property to perfortn the work for which application is made and I comply with the <br /> State ontr ctors Law 18. CW d 296.200 WAC. <br /> � <br /> . - yv v5 � <br /> Sig ure of Uv rl ontractodAuthonzed A nt Date / <br /> � <br />