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bf <br /> • a.� <br /> P`�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 n �a��� <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org �b <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � p(�U� —FJI�I� <br /> SITE ADDRESS • PARCEL TAX I.D.# PERMIT M <br /> . rna1l�. �/,�� Qri� a90517oo1b27oa �5� <br /> LEGA T NO. BLOCK TI2ACT <br /> DESC. � . �p � F� 42S• 3? �.Il6S <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �L�}��Bv��°�f�llfs Boxy33 ��o��S�l, I,�9 (tizs�a3a�733 <br /> TENANT NAME CONTACT FOR PERMIT ����PHO E <br /> I �uq �n dson �5�-9aoa <br /> Mai7' a31-8 3 <br /> CONTRACTOR li � y� GDY inai+� ADDRESS ���/7 CITY2IP PHONE <br /> CONTR.LICENSE# � ,I B`�p 3 a�r5 �Q�, `Q�"�Jens� W�l (�'�5�9a3-47�� <br /> �r�A G r7 <br /> ��Sr�gt'�p��u� HEAT SOURCE CONTRACT PRICE OF WORK <br /> �I I <br /> Y f�u � _Electric �Gas_Olher `�3��n � <br /> i <br /> WORK DESCRIPTION <br /> ue�J �rucl�o'n .-� -- . <br /> ,,,, �,� ,C o,�.c— <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _�; Toilet A/C—air handling units <br /> � Bathlub 1 Forced afr systems <br /> Lavalory(wash basin) � Gas piping , <br /> Shower � Water healer <br /> I Kilchen sink 8 disposal � Gas fireplace <br /> I Dishwasher Gasraoge <br /> i Clolhes washer ,�_ Cblhes dryer <br /> � Waler healer I Range hood <br /> �_ Sink(service/badmop/elc.) � Exhausl fan <br /> Backtlow prevenler _ Heal pump <br /> Urinal _ Unit heater <br /> Drinking Founlain _ Boiler <br /> Ftoor drain Retrigera;ion <br /> Greaso lrap _ Woodstove <br /> Roof drains Other <br /> Other — <br /> CI7Y OF EVERI?TT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y Ihat I have read and examined lhis application and know the same to be true and correcL All provisions of laws and <br /> ordinaces goveminc�this type of work will ba comp�ied with whelher specified herein or nol The granling of a permil does not presume <br /> to c�ive aulhority to violate or cancel the provision of any olher slale or local law regulaling conslruction or the performance of <br /> construclion.That I am aulhorized by lhe owner o(lhis property to peAortn lhe work(or which app�icalion is made and I comply with lhe <br /> Slalo Conlractors Law 18.27 RCW and 296.200 WAC. <br /> a.�,,�'�c+.rr—� � I � <br /> Sig atur (Owner/ onlraclor/Aulhorized Agenl Date <br />