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, <br />PERMIT <br />APPLICATIUN <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 <br />SITE ADDRESS <br />3�y 55�. PL su� <br />BLOCK <br />PARCEL TAX I.D. # P RMIT # <br />G��1.3(� �iU00t� /�/� 2 I� Cvo )- lo <br />TRACT <br />5ir.5.4-n1 nC�-p��ytl�rV OU, aC7)( vl�-� /Yl�i,Lr��-U •az6,»sf-oBG�` <br />�,y.a-� S <br />TENANTNAME <br />CONTACTFOR <br />CONTRACTOR (�,4V ,f-�(/ f � ADDRESS <br />PLuma;,.;� d-I-l�ri.�i- /GG!�l /3�.��:.�J <br />CONTR. LICENSE # <br />D9-Y�/�- f�it n t1 Zl Civt <br />USE OF BUILDING <br />HEAT SOURCE <br />Electric _ Gas _ Other <br />PHONE <br />�(Z5 � �7s -� i/G <br />CITYIZIP PHONE ({ZC> <br />�Yn/n�cuO�iD �-,5 �yG�/ <br />�if�3-� <br />CONTRACT PRICE OF WORK <br />� �� .`7�tJ, C� <br />WORK DESCRIPTION rJ��/L� , /��� `��� � �w�C� ��` C� / 7 � �' 7�L_ <br />K /v <br />� /�zu<5 � . <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Back(low preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />o�he���r_�� s�=�zu.�cc ;-2��nt- GrY <br />m E rc�=- TD h�-o �t 5c <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 goveming this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to c�ive authority to violate or cancel the provision of any other state or local taw regulaling construclion or the performance of <br />construction. That I am authorized by the owner of this property to perform the work tor which applicaUon is made and I comply wilh the <br />State �C °ftractors La�$�7 RCW�� �an ') 6.200 WAC. <br />-�r��4. w��/�IC -' �7 -�� �� <br />