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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.orc� <br /> APPLICATIONS ARE ACCEpTED FROM 8 AM TO 4 PM <br /> SITE ADDflESS PARCEL TAX I.D.# PERMIT# <br /> �s�9 /o.�� A sE Ua�la�-s4 �-/� i1n 9ra � ��a- I <br /> LEGAL LOT N0. BLOCK TRACT OR SUBUIVISIOi:d <br /> DESC. ' <br /> OWNER ADDRESS CITY2IP PHONE <br /> DAViO �H2Kc �v��9 /O�� �•S� 9�� 4�-51�3-PS't-(Z <br /> TENANT NAME CONTACT 20R PERMIT PHONE /� �/ <br /> LY�7M" /�—.�YC(i/� �E M IL'JS tG 7GL� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> DRt�d-,�,� oi�B� �-y� �GG�y �3� A-�'w �Y,�,�. `�ZS��s-� /v <br /> CONTR.LICENSE# �r/� —r � � <br /> DFI'S�N�P/f9�/� a <br /> USE OF BUILDING HF SOURCE CONTRACT PRICE OF WORK <br /> I _Electric ;�Ga�_Olher I yf' %✓C� � <br /> WORK DESCRIPTION <br /> f�EoGA-�E �X�sn�- �7-fl5 �2,�A� Gt�i7a a/P� <br /> G�1-s �ni�A-cE ,� .�1r�� LocATI�-�i <br /> � NCJ N�� �f}-S �P Pr N . <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FI%TUflE OR ITEM N0. TYPE OF FIXTUFiE OR ITEM <br /> Toilet A/C—air handling unils <br /> Bathlub � Forced air systems <br /> Lava�ory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer � Clclhes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/eic.) Exhausl fan <br /> ___ Backllow preventer Heat pump <br /> Urinal Unit bealer <br /> _ Drinking Founlain _ Boiler <br /> __ Floordrain _ Refrigeralion <br /> _ Grease Uap ._ Woodslove <br /> Roof drains .._ Olher______ <br /> _ Olher <br /> CITY OF EVERETT LOCAL SALES TaX CODE IS 3105 <br /> I hereby ceritify�hat I have read and examined this application and know Ihe same�o be irue and correct. All provisions of laws and <br /> ordinaces governinq�his lype of work will be complied with�vhelher specified herein or nnL The granling ot a permit does not presume <br /> lo c�ive au�hority to violate or cancel the provision of any other s�ate or local law regulating conslruclion or the pedormance of <br /> conslruction.That I am auihorized by the owner of this property to pedorm the vrork(or which application is rnede and I comply with the <br /> Stale Canlra rs Law 18.27 R W and . �0 WAC. <br /> � l � /�/���''J <br /> ( 7� ; <br /> Sic�na�ure o O iedCon�raclor/Aulh iz d , 1— Dat� <br />