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PERMIT �►PPLICATION <br /> CITY OF EVERETT PER��AIT 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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �f�z� �=vs . ���,� GU M oxo9 �S <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER AOORESS CITY2IP PHONE <br /> TENANT NAME CONTACT FOR PERMIT �"(,p HONE <br /> l Gf/��L�/l'� C�WU±�S/!rL/ E MAI�3� I T z� <br /> dOC(n< O/� <br /> CONTRACTOR ADDRESS GIIYIZ P PH NE <br /> �%�/•,�t�- .SU�P.S � 5�'�'v� ��� 3�0� F�r�/���e. /,peD( G�L >-ZS%-Z/ <br /> CONti{t LICENSE# , L P � <br /> ,�'YG�/b�SSO�l z-/� Z �•,^ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �/y�/Yf _Eleciric �Gas_Other Z y�� <br /> � <br /> WORK DESCRIPTION /� / L ,C <br /> ,%1'��7)OU'L' '� /1���?/e �l/7��7�//'P`�/ f/� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTl1RE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Force�air syslems <br /> Lavalory(waah basin) Gas piping <br /> 3hower Waler heater <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> VJaterhealer Range hood <br /> Sink(servicelbar/mop/elc.) Exhaust fan <br /> Backflow prevenler Heal pump <br /> Urin2! � Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Retrigeration <br /> Grease trap Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this application and know the same to be lrue and correct. All provi;inns of laws and <br /> ordinaces governinc�this lype of work will be complied with whether specified herein or nol.The granting of a permit does not presume <br /> lo c�ive authority lo violale or cancel the provision of any olher state or local law regulating conslruction or the performance of <br /> conslruclion. That I am aulhorized by the owner o(this property to perform the work for which application is made and i comply v;ith ihe <br /> Stale Conlractors Law 18 /7 RCW and 296200 WAC. <br /> ���I � �_ y`�8. <br /> SignaWre of Own dConlraclor/Aulhorized Agenl Date <br />