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PtRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-dG57-�vww.everettwa.arg <br /> APPLICATIONS ARE ACCEP'i'ED FROM 6 AM TO 4 PM <br /> SITE ADDRESS � PARCEL TAX I.D.# I �`MIT q <br /> �2� i� a�v�. E���r-r Zao53c���a�2do �J��� i� <br /> �_EGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> (tWNER ADDRESS CITY2IP PHONE ���5� <br /> P'R�VtDENGE EYEFzG1T' 1321 COLSY r�VE.� 1?0. ��C II�F"7 �YE7zET(' %E320�� .?6( .q{��33 <br /> MES71c'.+nL GEf-CrEt� <br /> TEI'�ANT NAME CONTACT FOR PERMIT PHONC• <br /> f�o�tpEc�(cC �VE'�-T�1-' �Ylt�! SAYL0�2 C�F25� 2E��-0868 <br /> r�vtcP.� caticr�rz <br /> CONTRAC7'OR ADDRESS CITYlZIP PHONE ��, <br /> KI'F�R-�Y �� A`f--�(��S Id1oS� EYEP-ET�'I� MALL- WAY C4'J�j72lal •.=�r�4J2 <br /> CONTR.LICENSE# S UI'(� (02 ���, �8�� <br /> ic�izt-'t_GP� 2-72RF <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> a�rf"!`�P.TIEhtt- GLtt-tlG BL�X'�t.l � '��� 280. C� <br /> PttAfZM�°�GY __Eleclric �Gas_Other <br /> WORK DESCRIPTION <br /> {2�Mb[�(� �f�t�lA(-�T� lMj'��`C�-(�Et�T 6� �2Gk�-'Yif�C'� <br /> �YS�r FLLO� 1�NARr�r(P.c.:Y (SIJn"E 14p� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC-air handling units <br /> —I 8alhlub _ Forced air systems <br /> L.�valory(wash basin) _ Gas piping <br /> Sl�ower W ater heater <br /> Y.iichen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas renge <br /> Clothes washer _ Clothes dryer <br /> Waler healer _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust ian <br /> Backflow prevenler _ Heat pump <br /> Urinal _ Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeration <br /> � Grease trap _ Woodslove <br /> Roo(drains _ Other <br /> Other — <br /> CITY OF EVERETI'LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceriti(y lhat I have read and examined lhis application and koow the same lo be true and cortect. All provisions of laws and <br /> ordinaces governing this lype of work will be complied with whether spacified herein or not.The granting o(a permil does not presume <br /> lo give aulhority lo vio�ale or cancel lhe provision of any olher stale or local law regulating consWction or lhe performance of <br /> construclion.That I am authorized b/the owner of this property lo per(orm lhe work for which applicalion is made and I comply wilh the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> � 5-14-0� ('� <br /> Signature of 0 medCon 2cTbStAnih nze Agent Date � y�\ <br /> �, <br />