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PE�r�MIT APPLICATIa�� <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 - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.i� P RMIT� <br /> 1 �� — <br /> Do G�iII Crer�c ��ik� Z g° �Fo Zoo3o1-S�uo <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ht err�c � c-re�/� LL c 60o V.,, „ui•< S-{" S�t�{�� � C .E <br /> TENANTNAME <br /> CONTACT FOR PERMI " PHONE <br /> G.J {n i e Z- Sfc_ut l�Lo,.i � �I z5= 776-b'8 3S� <br /> CONTRACTOR t3��r NG.,✓ c c ADDRESS CITY2IP PHONE <br /> r 7y�o N�.•I.�o.. aa /�js- 7J6 Sfr35- <br /> CONTR.LICENSE# . �L,vc r�l{J �,.� SfjZo�i <br /> /Je'i�y.v<o 7�c /.� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 1 Electnc _Gas_Other <br /> ,� �OO UG <br /> (✓I���NvyC — <br /> WORKDESCRIPTION �ti�9�� /�) $�.(� �{ Nu.v Lr { �� uel�t G- �+�vuet L�hFe.'S <br /> L <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE CR ITEM NO. TYPE OF FIXTURE OR ITEM <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 /> D'.shwasher _ Gasrange <br /> Clothes washer _ Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/Tr^/etc.) _ Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> I _ Unnal _ Unit heater <br /> Drinkin9 Founlain _ Boiler <br /> li Floor drain _ Refngeretion <br /> � Grease trap Woodstove <br /> � Roof drains _ Other <br /> Other_ — <br /> CITY OF EVERETT LOCAL SALeo 7:.X CODE IS 3�05 <br /> ;I I hereby cerilify that I have read and examined this application and know the same to be true and correcL All provisions of laws and <br /> i ordinaces governing this type of work will be complied with whether specified herein or not Thc granting of a permil does not presuma <br /> ' to give authonty to violate or cancel the provision of any other siate or local law regulating censlructlon or the performance of <br /> construction.That I am thorized e of ihis property to perform ihe work for which application is made and I comply�.vith the <br /> I State Contractors La 8.27 a �AC. <br /> , Signature OwnebContractodAulhonzed Agent Date ��a <br /> i <br />