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P MIT 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 <br /> SITE ADDRESS PARCEL TAX I.D.S PERMIT# <br /> r�:��J�J��lrh e 5C� Svi4c, j0( �o� , / <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS CITY2IP pHONE <br /> ���n f�-r�� �,�, ��333 i9m 5c s��k �o� ���tk �2ay <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �,���h N�!�5+n�n� �3-����,� <br /> CONTRACTOR GY�Gr��I� 1�/C uL DORESS CITY2IP PHONE <br /> I(o;�,� ci2avru; p.�� �(��� 253 ���-2,C� <br /> CONTR.LICENSE# �, ,k�f�Q� <br /> C�JIG 2{�F�`i$ON�Q `�� �32�I <br /> tISE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �i��G�� Eleclric Gas�Iher <br /> WORK DESCRIPTION <br /> `�em��it 1 S�n ni�(�✓ �,�slv�^n <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM . <br /> Toiiel AIC—air handling units I <br /> _ Bathlub Forced air systems <br /> Lavarory(wash basin) Gas piping I <br /> Shower Water heater ' <br /> Kitchen sink&disposal Gas Tireplace <br /> Dishwasher Gas range <br /> Cbthes washer Cblhes dp�er <br /> Waler healer Range hood <br /> Sink(service/barlmop/etc.) Exhaust fan <br /> _ Backtlow preventer Heat pump <br /> lhinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions ot laws and <br /> ordinaces governing this type of work will be compliedµilh whelher specifled herein or not.The granling of a permit does not presume <br /> to give authorily to violate cr cancel the provision of any other state or local law regulaGng construction or the peAormance of <br /> construction.That I am authorized by the owner of this propeRy to perform the work for which application is made and I comply with the <br /> State Contractors Law 1827 RCW and 296.200 WAC. <br /> '/.r�*/-C1ld�'l �11771, d�� ,',�/�calo /// <br /> Signatur� wnedContractodAuthorized Ageot Date � <br /> � ' <br />