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PE�MlT APPLICAYIOov <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 - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �ya s' 3 � �" �05� �002� 6o 0 4�9 I BoyoB �o�_. <br /> LEGA LOTNO. BLOCK TRACT ^ p <br /> DESC. ) <br /> i^ f ,Q,+"� <br /> OWNER A�DRESS CITY2IP PHONE <br /> ��5 2s9-94.ss <br /> i�iLL: S7-re�T ZI�U�S T»�P ►a T �l'C�. �,�Sys'9 �Z�,-�LQ.� <br /> TENPNT NAME �� CONTACT FOR PERM PHONE <br /> YW1 . Y1s�.f,�K-a-`^*-Q I -�-�9-°.'v`Q 'Q'``'� 3��,��q-213� <br /> CO TRACTOR � ADDRESS CITY IP PHONE <br />�' �,�c�.'''� � ,2766 y (,y� G�-v2.�l w 57,9 N�o ap -�6G, ��q- �l 3 <br /> CON�fR LICENSE# � <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> � � � S�-�� _Electnc _Gas_Other I � L,'Z� D O'� <br /> WORK OESCRIPTION �� <br /> � �0 7��3.�`_ <br /> ���.X/O d ���f-�j�� � . <br /> PLUMBING MECHANICAL <br /> �O. TYPE OF FIXTURE OR ITEM � �- NO. TYPE OF FIXTURE OR ITEM �- <br /> _ Toilet A/C—air handling units <br /> _ Bsthtub Forced air systems <br /> _ Lavatory (wash basin) Gas piping <br /> __ Shower Water heater <br /> _ Kitchen sink& disposal Gas fireplace <br /> ___ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> _ Sink (service/bar/mop/etc.) Exhaust fan <br /> _ Backf!ow preventer Heat pump <br /> _ Urinal Unit healer <br /> _ Drinking Fountain Eoiler <br /> _ Floor drain Refrige2tion <br /> __ Grease trap Woodstove <br /> _ Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> iI hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with�vhether specified herein or not.The granting of a permit does not presume <br /> to give authonty to vioiate or cancel the provision of any other state or local law regulating construction or the performance of <br /> ; construction.That I am authorized by cne owner of this property to perform Ihe work for which application is made and I comply with the <br /> State Ccntract s Law 18.27 RCW and 296200 WAC. <br /> � ��' �.��-�,.� �� �„Q,, � g,�� % <br /> I Si��ure ot O�tractor/Auth�nt Da 1/� <br /> , <br /> �Yti� <br />