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PErtMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> t 3200 CEDAR STREET, EVERETT,WA 982G1 <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.S P IT# <br /> Jyl3 .�-o, �� s< <� ��socx�aua-�� ��'°3 � 7 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> CWNER ADDRESS CITY2IP PHONE <br /> /��,�lP .5,�n10�5 y�ll� �.vn. D�� SG E✓erErl `I�,�B �l 25-�.35�-9�JOy <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> 8�'-yq-,v �-oc��� � a� - ��s-U�r� y <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> DaY �- N�rc r��,�,��,,�c-�- N-rG- �����1 i3� A� l<J LYJn�l,�/CYJD yz� ��5 � yl�/ <br /> CONTR.LICENSE p � <br /> DAyniiPrtGyyGv� _ �I��'-s� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> i <br /> �" _Eleclric _Gas_Other <br /> � <br /> WORKDESCRIPTION �iE��CE �'�".�-� 5��1'!C� �lZCyt2 n7e� 7Y� H���'r'�. <br /> � �/f� Fi <br /> PLUMBING MECHANICAL <br /> NO, NPE OF FIXTURE OR ITEM NO. TYP[OF FI%NRE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhiub Forced air systems <br /> La�;^tory(wash basin) Gas piping <br /> Shower Wa�er healer <br /> Kilchen sink 8 dispesal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray Ran�e hood <br /> Sink(service/bar/mop/etc.) Exhausl fan <br /> Backflow prevenler Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Gmase trap Woodslove <br /> Roo(drains Olher _ <br /> _� Olher,(,�_.��'�i� <br /> CIiY OF EVERETT LtICAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y fhat I have read and examined this application and know ihe same to be lrue and c;orrecl All provisions of laws and <br /> ordinaces goveming Ihis lype of work will be complied wilh whethcr specified heruin or not.The granting o(a permit does not presume <br /> lo give authority to violate or cance�the provision of any other state or local law regulating consWction or the peiortnance of <br /> construction.Thal 1 am authorized by Uie owner of this property to pe�form lhe work tor vihich application Is made and I comply with the <br /> Slate Co9Sractors Law 1827 RCW and 296.200 WAC. <br /> i J 9 . <br /> �✓�xw �,�, , � _ 3-Z�� �� <br /> Signat�wnedContractodAuth iz genl Date <br />