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PtRMIT APPLICATIUN <br />CITY OF EVERETT F�ERMIT 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. # <br />a�og rq �' Pc, w, �7ro3- aao- 030 -oo <br />LEGAL LOTNO. BLOCK TRACT <br />DESC. ,3U Oab �il/LYNO/UT EST/FTC� .U1✓• �' <br />� a 8-D� <br />Ff�4RoC.� ffuTcff/NSo� /oy08 /9� PL.W. 6vE2E'T �� Tpb-ZS�/8n3 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />$(L��JT u�A-!_f�2 �`: S-o240-950 ) <br />CONTRACTOR �y,�(�E2 EON57�RUU7O� ADDRESS y/f�.t/ 8?OA�DW�- CITY2IP PHONE �/ZS-ZR�'slSb 1 <br />S'!S. A EVER6Tf <br />CONTR. LICENSE# G.7/}!-KEG� (/.2F5.2 EXr ' 8'��Z-07 <br />USE OF BUILDING HEAT SOURCE <br />s F 1\ � Eleclric _ Gas _ Other <br />WORK DESCRIPTION <br />1�PLA�E F-�c15TiN6 ��NUFrsG7LtKEl� ytm�lE <br />irir}n� u Fi9-�Tu/�� !-rb�1 �. <br />NO. I TYPE OF fIXTURE OR ITEM <br />Toilel <br />Ba!hlub <br />Lavator,� (wash basin) <br />Shower <br />Kilchen sink & disposal <br />_ Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/badmop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Other <br />CONTRACT PRICE OF WORK <br />eo <br />,� /S�d00, <br />wi�£ rf- NE� <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />A/C - air handling unils <br />Forced air systems <br />Gas piping <br />Wa;er heater <br />Gas tireplace � <br />Gas range � <br />Clolhes dryer <br />Range hood <br />Exhausl fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woadslove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />I hereby ceriti(y that I have read and examined lhis application and know the same to he Irue and correct All provisions of laws and <br />ordinaces c�overnine� lhis lype of work will be complied with whether specified herein or noL The granling of a permit does nol presume <br />to give authority to violale or cancel lhe provision of any other stale or local law regulating conskuction or lhe pedormance of <br />construction. That I am aulhorized by lhe owner of this property lo per(orm the work (or which application is made and I comply with the <br />Stale Conlraclors Lzw 18.27 RCW and 236.200 WAC. <br />�- ,o__ %�__.— //^�-a� <br />�ignalure of OwnedContractodAulhorized Agent Date <br />