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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 1 PM <br /> SITE ADDRESS PARCEL TAl(I.D.# PERny�A <br /> y6�► S;Jvez�'��� Oo(ol/eZ0000l300 � �Y �� �� <br /> LEGAL LOT NO. BLo�K TRACT OR SUBDIVISION# <br /> oesc. /3 po doo W�j' l2;oye /�u��� <br /> OWNER ry�;//e �G�� A n.I) ADDRESS CITYIZIP PHONE <br /> //. n yGa I S rluPn.'�,,P I�c �v. c!d'aa3 v��•�.s-8 N990 <br /> TENANT NAME � I CONTACT FOR PERMIT PHONE y�l���j� <br /> /r11KerG�..ff.� �'in�� .T�f� 9�y8 <br /> E-MAIL <br /> NTRA TOR �^Q G� OM eM, �'yL ADDR SS p'�7' �Y�J CITYI IPf � P NE �J'Y�89�B <br /> ,l�}, 9d'�a3 <br /> CONTR.LICENSE# � �vs Rr q q �o G �� —I (..�' V j _ <br /> USE OF BUILUING HEAT SOURCE CONTRACT PRICE OF WORK <br /> y�M& _Eleclric _Gas Y Olhcr �.5� (/1�U• 00 <br /> WORK DESCRIPTION <br /> f';N��1�;�g o-� ¢K�S-�:�� bRsew,e�' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. � TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C—air handling units <br /> — 8�����ii�� Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> �_ Showur _ Water healer <br /> Kitchen sink&disposal _ Gas(ireplace <br /> Dishwasher __ Gas range <br /> Clolhes washer _ Cbthes dryer <br /> Waten c�alei kanc�e hood <br /> 1_ Sink(serviceNadmop/elc.) � Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal _ Unil healer <br /> Drinking Fountain _ Boiler <br /> rloor drain Refrigeration <br /> Grease Irap _ Woodslove <br /> Rool drains _ Olher _ <br /> Olher — . <br /> CITY OF EVFRETT LOCAL SALES TAX CODE IS 3105 <br /> I herehy cerili(y that I have read 2nd examined this application and know lhe same to be true and .:orrecL All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether speci(ied herein or noL The granling ot a permit does not presume <br /> lo give aulhorily to violale or cancel the provision ot any olher slat�or local law rec�ulaling conslruclion or ihe perfomiance o( <br /> consiruclion.That I am aulhorized by lhe owner of this property to pedorm ihe work for which applicalion is made and I comply with Ihe <br /> S�l�al�r.�.ontraclors La� 18.27 RCW and 296.200 WAC. � � <br /> C�J 1.e`��-- �" ��� --��1�� <br /> Si�nature ot OwnedCon�ractorlAuthonzed Agent Dal <br /> � <br /> I_._—_. ---- -- - �—� - �--�----� -- -- — —. <br />