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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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S— '�--�� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT p <br /> � / f Gaa� Rc� � 8'0l0 900 � D�1f o0 �0�s,GS G C 3 <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> OESC. <br /> �OWNE ADDRE55 CITYIZIP PHONE S/�,s"' <br /> -- /��,'f��.� � 8'/6 � .,�,ti,� [.r,by--,�d���3 35,��//// <br /> TENANT A CONTACTFO ERMIT / PNf1yE_�71'r�� ��D7 <br /> �w�.� y Y�,C <br /> v"l. �(/L '1pYQpIyC � E�MAIL.Jr <br /> �N� Go.�.�C. �� ,�y / " �7�f''/-9�oT <br /> CONTR.LICENSE N 0��a 2 �� `/ SE `���� <br /> (�J`Fnrb� /'_�L �y�/ri� !�� d - <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> n9 F _Glectric __Gas_Olher ��� �60 . � <br /> � � F <br /> WnRK DESCRIPTION 'L / <br /> ,�i�/�t�T/Oma c�/ �//r' . <br /> 1 <br /> -1� �. L�z�� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling unils <br /> Bathlub Forced ah sysloms <br /> Lavalory(wash basin) _ Gas piping <br /> Shower W aler hoalor <br /> Kitchen sink 8 disposal _ Gas liroplace <br /> Dishwashcr Gasrange <br /> Clolhes washm Golhes dryer <br /> Water heater Range hood <br /> Sink(servicclbarfmoplcic.) __ Exhaus�fan <br /> Backllow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boller <br /> Floor dr2in Rofrigeration <br /> Grease trap _ Woodstove <br /> Roo1 drains O�her <br /> Olhei <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS�705 <br /> I hereby coritify Ihal I have read and examinod Ihis applicalion and know the same lo be lrue and correcl All provisions ol laws and <br /> ordinaces govemin�lhis lypo of work will ba complied wi�h whelher spoci(iod herein or nol The granling ol a permil doos nol presume <br /> lo givo aulhorily lo violale or cancel ihe provision ol any olhar state m local law regulaling wnsiruclion or the peAortnance o� <br /> conslructiun. Thal I am authorized by the owner of this property lo peAorm the work for which application Is made and I wmply with the <br /> S�a�e Con,a lors Law 18. 7 RCW and 296.200 WAC. <br /> �- /�73-d� <br /> ure ol wnedConlraclor Authorizad Agenl Da�e <br />