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NERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ( 3200 CEDAR STREET, EVERETT,WA 98201 <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 /> �53� F:uc/cC� /�tre- UD 9Z�� 53.253 ZG� �����-_3 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITY2IP PHONE <br /> pqu� �FIOnIA �C-n'iLEY ,253Z /LuCKElt- �{i�e'_ � �{��d( q25;�o�-3G�v� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> a�� ���,� �rZs-��s-����r <br /> CONTRACTOR DAY�'N1rE P�.uma�NU ADDRESS /(�(���{ �j /�.l.(�CITY2IP PHONE <br /> ,�,vo neAn�ir LYnliucucr�D� wk �'�Ss��� �fZs-��S-6Y�� <br /> CONTR.LICENSE N D/��L I�N��{U G� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Eledric �„Gas_Olher � (p��( Z�. �7 <br /> WORKDESCRIPTION k'EFGA-GE EX1� 7/�G' �R�S TZl.�'��f"� W�r� N'CG� �s <br /> Fce�,�.h-cE � AT/o /'�-E-Pc�-r-� �xi s t�n/G- r cuR-�T T� <br /> T,q,v,� tv� n� N�w -fhrvCLEsS �r�4S /� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhtub = 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 <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/elc.) _ Ezhaust tan <br /> Backflo�v prevenler _ Heal pump <br /> Urinal _ Unit heater <br /> _ Drinking FouNain _ Boiler <br /> Floor drain _ Refrigeralion <br /> Grease trap _ Woodstove <br /> Roo(drains _ Other <br /> = Other =I <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify Ihal I have read and examined this applicalion and know the same to be We and correcL All provisions of laws and <br /> ordinaces goveming this rype o(work will be complied with whether speci(ied herein or nol.The granling of a permit does not presume <br /> to give aulhonry lo violale or c2ncel the provision of any olher state or local law regulating conslruction or the peAormance o( <br /> constniction.lhat I am aulhorized by lhe owner of lhis property to peAorm lhe work tor which application is made and I comply with the <br /> Stale Co�;actors Law 18.2�7 CVV and 296.200 WAC. <br /> �/�,.�,,�L `�4-�� y-��-aG, <br /> Signature wnedContractoqA on ed gent Date <br />