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PEKMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES 3- �o -0 6 <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 /> SITEe D I� Gec�.n�� �J�P7CE/ C� I v`� SC)..2 �� PE�T# 3_GZ`' <br /> ..D <br /> 3 <br /> LEGAL LOT N0. BL K TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ►....� � ��� Pa- L� c� 30/0 (z-r.��'1l- �'v��-h� <br /> TENANTNAME n CONTACTFORPERMI PHONE <br /> 1-�0�:�� I" u- Lr'�{� I � c�c Yue r,�l« ��S 330 -�S'�' <br /> CONTRACTOR �. ADDRESS CITY2IP PHONE <br /> C�.�S C (�<G ��j <br /> Caws�rv�'R�'.L �/l.2. /7(o"�/�L /�G/. l��L• W� �•t5 33�-7�5 <br /> CONTR.LICENSE N �r��scs gysQ K �5��-3 <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��' n (� .�e <br /> Sr/vfi/L `I"�L"� Gy I�P51!XL'r�x� �Electric �,Gas_Olher � � vQ4 <br /> U � <br /> WORK DESCRIPTION <br /> � � 4� � `�o� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhlub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> — Cblhes d er �, <br /> Clothes washer _ �Y <br /> Waler healer Range hood <br /> Sink(service/badmopletc.) _ Exhausl fan <br /> Backflow prevenler _ Heal pump <br /> Urinal Unit healer <br /> Drinkinc� Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap _ Woodslove <br /> Roo(drains Olher <br /> Olher <br /> � <br /> CITY OF EVERETT LOCAL SALES T/UC COOE IS 3105 <br /> I hereby ceriti(y Ihat I have read and examined lhis application and know the same lo be true and correcl. All provisions o(laws and <br /> ordinaces c�oveming lhis type of work will be complied wilh�vhelher specified herein or noL The granling of a pertnil does not presume <br /> to give authority to violate or cancel lhe provision of any olher stale or local law regulating construclion or the pedormance of <br /> conslruclion.That I am aulhorized by Uie owner of lhis properly to perform lhe work tor which applicalion is made and I comply�vith lhe <br /> Stale Contraclors Law 1827 RCW and 296.200 WAC. <br /> ��'-=J`'"„`�Gfr/ /-3/�ob <br /> SignaWre of Owner/Conlraclor/Authorized Agent Dale <br />