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I _ <br /> P�ERMIT 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 AiN TO 4 PM ( � / C ? � �� � <br /> SITE ADDRESS PARGEL TAX I.D.! PERMIT�� � <br /> 890� S��c 28tr�/3ooz.o72o0 � i�%03 - Jo� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESG. p Zp9 <br /> OWNER ADDRESS CITYZP PHONE <br /> �EFF 5LN�6GR B`304� 's� �E W �yLRE1l� qg2pcf yZ5 3yg•j(o <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> �.'�a�� 'rbN �s y2s•.�z� • 3�98 <br /> CONTRACTOR Ds�,�' TwN�s ADDRE55 CITYIZIP PHONE u��7,?G� <br /> DBA: T.�w�6 Ner,r nNc Rcmoocc.uc. � <br /> �/08 E. f�NinN sr, GRANrrE �Acc.S <br /> CONTR.LICENSE i �7 �(_; �j SZ �, <br /> T N/SNR�3OL$ 7 � . G � � <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �mAQ y Q���,��G� �Electric _Gas_Other I ,3��j�y. y8 <br /> i�� <br /> � <br /> WORK DESCRIPTION <br /> 7.�EE FE6� /N7� 2N� S7a0.v�. T�RH+�T TD WEPA12 RNO Pu►cE I�A�.E <br /> J <br /> PLUMBiNG MECHANICAL <br /> NO. TYPE OF FIXTllRE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toiiet AIC—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Klichen sink&disposal �� _ Gas fireplace <br /> Dishwasher / Gasrange <br /> Cbthes washer Clothes dryer <br /> _ Laundry lray / _ Range ho <br /> Sink(service/barlm /etc.) Euhausl n <br /> Backfiow prevente� _ Heal P P <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigera5on <br /> Grease trap Woodstove <br /> Roof drains Other, <br /> Other <br /> I CITY O�EVERETT LOCAI_SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and ezamined this application and know the same to be lrue and conect. All provisions of laws and <br /> ordinaces goveming this type o(work vnll be complied with whether specified herein or noL The granting of a permit dces not presume <br /> to give authoriry to violale or cancel lhe provision of any other state or local law regulating consLcction or the peAormance of <br /> constructioa That I am authorized by Ihe owner of ihis property lo pa�wrm the work ior which application is made and I comply with the <br /> State Contracrors Law 76 27/R�CW d 296200 WAC. <br /> �.�� -� �����v �- <br /> Sig �� Ow ontrador/Author¢ed Agent Dat? <br /> /� <br />