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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.org <br /> APPLICATIOrIS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE 26?0 pV tt4 `� PARCEL TAX I.D.N P tMI - /S <br /> O 1�I J oo813S0000200o JK ./�✓� <br /> LCGAI_ LOT NO. BLOCK TRA T <br /> DI°SG -10 000 -00 okdjelf. Ihi(l 1-fiyhlan�hs Diu. #2 <br /> OWNER ADDRESS CITV2IP PHONE <br /> Cha-is DmIols 7,630 seh Y�. Sw Eveaei+ 98743 yZSS '7091 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> NJA F4t uatman Zob, 3L41 1003 <br /> CONTRACTOR hADDRESS CITyrzIP 4925- 3rthAVe NE SeAt+le g81►S' Zc4 PHONE2, Sy <br /> Mva h Cv1�'am !-fom8t 4 ?2 <br /> CONTR.LICENSE! nGr <br /> -MAY14 C Pf 1)C, I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> '''aIL <br /> le f aN(N - �f_lecinc X Gas_Other <br /> WORK DESCRIPTION <br /> 22S•s( f+ 4dd'rie✓1 Ifpen- Flooe- Bonar 40M overt. <br /> Hcit}mn9 one shay thta4gAR&O'le b0Y' <br /> PLUMBING 1 MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C-air handling units <br /> _ Bathtub _ Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> _ Shower Water heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(servicelbarlmopletc) Exhaust fan <br /> _ <br /> Backflow prevenler Heat pump <br /> _ Unnal Unit heater <br /> _ Drinking Fountain Boder <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALE TAX CODE IS 3100 <br /> I hereby centify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordlnaoes governing this type of work will be compliedwith whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other stale or loci'law regl''ating construction or the performance of <br /> construction That I am authorized by the owner of this property to perform the work for which application is made and 1 comply with the <br /> S a 1 s Law 18 27 RCW and 296 200 WAC. <br /> f n�le+�ro1` <br /> igna r of O merl ontractorl ut onze gent ate <br /> 1 1/ <br /> Z <br />