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P'tR�VIIT APPLICATIuN <br />CITY OF ��'�RETT 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 <br />SITE ADDRESS PARCEL TAX I.D. # <br />�70 31 GOWP� �lD� f�os�-D <br />LEGAL LOTNO. BLOCK TRACT <br />oesc.� <br />OW NER ADDRESS <br />�os�- B�zAG,DU�- <br />TENANT NAME CONTACT FOR PERMIT <br />J�-s�N !��*.�1 <br />CONTRACTOR ADDRESS <br />.,Dir�.�t ��T.���o,v pD �x �zy <br />CONTR. LICEN E # <br />DI�G�L 9SSJG <br />USE OF BUILDING <br />HEATSOURCE <br />Electric _ Gas <br />WORKDESCRIPTION ��I/Gle- Dro✓P�Itrvau�F�,vcG <br />� Der`e�'�i�c/�Pet'�rf5 ��i��c0 m �e� <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />BalhWb <br />Lavatory (wash basin) <br />stw,•,er <br />Kilchen sink 8 disposal <br />Dishwasher <br />Cbthes washer <br />Waler healer <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grease trap <br />Root drains <br />Other <br />�a—�6�as <br />PHONE <br />�S �5y /fDo <br />ITY21P PHONE <br />�-ysoi�qgy�0 <br />CONTRACT' PRICE OF WORK <br />Olher � Q� (� �v <br />��g/"/i� � . GC!' /�1 D�/ <br />�i GGt�,2,� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air hand�ing units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas ranye <br />Clolhes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALE; TAX CODE IS �105 <br />1 hereby reritify thal I have read and examined this application and kr.ow the same to be lrue and correcL All provisions of laws and <br />ordinaces governing lhis type o�f work will be complied with whelhe: speci(ied herein or nol The granling of a permit does not presume <br />to give authority to violate or cancei lhe provision of any other stale or local Iaw rec�ul�ling construction or the pedormance of <br />construction. Thal I am authorized by the owner of this property to perform the work for which application is made and I comply with lhe <br />S�a�e C ractors Law 18. 7?W and 296.200 WAC. <br />/ 7 �Z//3/�oaS <br />