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r <br /> PE�tMIT APPLICATIO►N <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 ACCEPTEG FROM 8 AM TO 4 PM ,��"�.Q�_—. 1.1. <br /> SITE AD�RESS PA�E�T�I.D.jt PERMIT# <br /> {,SZZ �l�J '� (�J S 1170 � OG r� - G� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS dTY/ZIP PHONE , <br /> ll�l i.CJ�U` �`�Il? �"�-� u� �'2 � ��� �s�'"°`� <br /> TE A�NAME Gr� Qf�CTfORPERMIT ��� ����ZO <br /> Vr� <br /> CONTRACTOR AODRESS CITY2IP PHONE <br /> CONTR.UCENSE# � � <br /> USE OF BUILDING I %HEAT SOURCE I CO TRACT PRICE OF WORK <br /> �(j`� �/'G5'� Electric _Gas_Olher ' 7 � t! <br /> 7 <br /> WORK DESCRIPTION <br /> �oye- �H-2S �! �7oRf►G►-lj- <br /> PLUMBiNG MECHANICAL <br /> NO. IYPE OF FIXTUR[OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet fvC—air hanGlir�unit� <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Cloihes washer Clothes dryer <br /> I = Waler healer = Range hood <br /> Sink (service/badmop/elc.) Exhaust lan <br /> I BacktleW prevenler Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease tra� _ Woodstove <br /> Roof drains _ Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby rilify t ai I have read a A examin2d Ihis application and know the same to be true and correcL All provisions of laws and <br /> ordinace gover ing t 's typo of �ork will�o complied wilh whelher specilied herein or noL The granting of a permit does not presume <br /> to givo a thonly o v' I le or cai el Ihe provisior,ot any other slale or local law regulating wnstruclion or the pedormance of <br /> conslruct n.Th t I m auth riz by the owner of this property lo perform the work(or which application is made and I comply wilh Ihe <br /> Slate Con acto s aw 8. R and 296.200 VJAC. ( <br /> U <br /> / <br /> Signature f ner tracto t on d Agent Date l/1 <br /> i <br />