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PEFtMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9A?:; <br /> 425-257-8810- FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# / PERMIT# <br /> � � s(� �74������10700 � � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYlZIP PHONE <br /> EVE�c� y25-5(3�, <br /> f?�cK �(/i��-�� yi� �a��Lc-�� ���r, scv 9Sao3 2/ <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> B��r� �-o� �r2s-��s-�q�y <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> DRY d-n��r� O��ns� � /f�U i6��(4 13.� /��. W. L s�;�niwcr�D yz5-7�-�c�C� <br /> CONTR.LICENSE# C7 f O J'J <br /> --�AVitJ�'P1f0 4�C/>'l 7 a i <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> _Eleciric �Gas_Other y� ��7��w <br /> WORK DESCRIPTION <br /> iQ�PLAc� �xr 6nN G- G�s Fu�av,�c6 u��7►t NEw Gr35 <br /> i �U2n�,f}-cE• <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilel A/C—air handling unils <br /> Bathtub = Forced air systems <br /> Lavalory(wasli basin) Gas piping <br /> Shower Wa�er heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Waler heater Range hood <br />� Sink(serviceNar/mop/etc.) Exhausl fan <br /> Backllow prevenler Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeretion <br /> Grease lrap Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat I have read and examined this application and know the same to be true and correct. All provisions of�aws and <br /> ordinaces governin�lhis type o(�rork will be complied with whether specified herein or noL The granting o(a permit does nol presume <br /> to give authoriry lo violale or cancel Ihe provision of any other slate or tocal law regulalinc�cunsWclion or lhe pedormance of <br /> � conslruction.That I am aulhorized by Ihe owner of this property to pedorm Rie work for which applicalion is made and I comply wilh tho <br /> � Slate Co Iractors Law �27 RCW an 6.200 WAC. <br /> __}��'L Y'`l"`flL�;�� / �� C�/�/�) <br /> Signalu o(OwnedConlreclor/A nl Date <br />