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PERMIT APPLICATIuN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, CVERETT,WA 982U1 <br /> 425-257-8810— FAX 425-257-8857—ww,v.everettwa.org 5..yd� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> z�o � w�� ��� i�> 3�%iG�2�� .mio0 � z" �7--� <br /> IEGf.L LOT N�). BLOC11K TRACT OR SUB�IVISION p <br /> DESC. I�L- 3-"� (QZ.�O y-DO <br /> OWNER ADDRESS CITYIZIP PHONE <br /> iMi,� l,t�lkr�� 2�o v�t�0!� h� St� 30� � 94�1r� ► Cu�)Zs�- y��8 <br /> TENANTNAM[ CONTACTFORPERMIT PHONE�SOt�� cj3Q 'O2S�I <br /> �.�IC'R.ETI VIN�`��R'J WR�(F�E P�R-�OV✓� E-MAILWhVNEPURAOM� . <br /> TRA TOR D C IZIP <br /> p INSKI �itRJ��Or� `� I ,'fA <br /> CONTR.LICENSEp ",�'�JDA7 �vri ��'I�'� PL gU�` W�T ��Z'S)�LZ- D�I}- <br /> PiNSKI CL°132G8 ;ll�'�� �id(lll <br /> USE OF BUILDING � � HEAT SOURCE CONTRACT PRI:E OF WORK <br /> / NUR��L _Elcclric �Gas_Other � S �V�� <br /> l.. �'i <br /> WORK DESCRIPTION <br /> %� / <br /> , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A1C-air handling units <br /> DathWb Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Shower 1Naler heater <br /> Kilchen sink 8 disposal Gas fireplaca <br /> Dishwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Waler heaLr Rango hood <br /> Sink(serviceNar/mop/etc.) Exhaus[fan <br /> Dack(lo�v prevenler Heat pump <br /> Urinal Unil healer <br /> Drinkin� Founlain . Boiler <br /> Floor diain Refrigeralion <br /> Grease lrap Woodstove <br /> Roof drain�: Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby cerilily Ihal I have read and examined Ihis apnlicalion and know the same to be trua and correcL All provisions of laws and <br /> ordinaces governing ihis lype ol work will be compliec wilh whelher specifed herein or not.The granting ol a permil does not presume <br /> lo c�ive aulhorily to viotale ur cancel ihe provision ol�ny other slale or local law regulating conslruclion or the p�r(ormance of <br /> construction.Thal I am aulhorized by ihe ov:ner of this property lo pedorm the work for which applica'ion is made and I comply with the <br /> Stale Co ilraaors Law 1 i3.27 RCW anA 29C,200 VVAC. <br /> �(�� ( �e <br /> Sic na�ure i f Owner;ConlraclodAulhorized Aqen1 Date <br /> �/� <br />