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s._ <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � � _�y ��JG' <br /> SITE ADDRESS PARCEL TAl(I.D.tF PERMIT p <br /> II4o5 S� IuLrl,Cike l�r��dc 28D53000lo3loD ooe�� -�o <br /> LEGA LOTNO. BLOCK TRACT S b TW ZS 12(� O 1�"f-S�1^S -5 <br /> oEsc. Y N A1 li � h L �]OYT WT 5AS MrJ�"5 W M N �v E�� a <br /> OWNER A DRE I PHONE(.��5 <br /> C�T`i or EVG'��-� 3?�v �E�- sTv�-=T� �dla�-err �g2os <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> e�T�� o F E���-r a�.�ey ,�2v� N NZs� zs-,.��4� <br /> CONTRACTOR ���26 EJ�GE�ev�c�SAooRess p p. �gox �fj CITV2IP PHONEZ�` &.�2�S�l <br /> KF..�J i �D35 � <br /> CONTR.LICENSE N �L I V CI�GSDO�(jl,� <br /> �—l4 07 <br /> USE OF BUILDING HEAT SOUR CONTRACT PRICE OF WORK <br /> '��.`O I I.� � _Electric _Gas_O�her Cj� � �$'�� �(� <br /> WORK DESCRIPTION �rn 0 I ��l($V1 O �� �kI St1 � ,t 0 U SC S <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A!C—air handling units <br /> Bathlub Forced air syslems <br /> � Lavatory(wash basin) Gas piping <br /> Showei Waler healer <br /> _ ::itchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Watcr heater Range hood <br /> Sink(service/bar/mop/elc.) Exhaus�1an <br /> Backllow prevenler Heat pump <br /> Urinal Unil healor <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeralion <br /> Grease trap Woodstove <br /> Roo(drains Othr.r <br /> Olher <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined lhis applicalion and know the same to be true and correcL AII provisions of laws and <br /> ordinaces c�overnin Ihis type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authorily t iolate or cancel the provision of any olher state or local Iaw regulating wnstruction or the perfortnance of <br /> constructio T t I am autho ized by the owner o(this property lo pedorm the work for which application is made and I compty with the <br /> State C ors Law 8 RC and 296200 WAC. <br /> SignaWr o:0 edConiracror/Authonzed Agent Date <br />