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PEF�N6GT APPLICATION <br /> CITY OF E:V�RETT PEY�MIT SERVICE5 <br /> 3200 CEDAR STREET, EVF:RETT,WA 98201 <br /> 42'r257-8810- FAX 425-257-8857-www.everetiwa.org <br /> �Ll(,��� AAPLICATIONS l�RE ACCEPTED FROM 8 AM TO 4 PM 7•-�—D q <br /> SITE A�DflESS PARCEL TkX I.D.# P[RMIT# <br /> _�e�-���..,_y �• a s3�aooa�Q,3�__—�9�� -�— <br /> LEGA L0T NO. BLOCK TRACT OF SUBUI\�ISION p <br /> DESC. D.1�p 'Pl'���yE rtElrD Z� <br /> OWNERGOc_D�hj�,�} 'F'(2p�,`r�� Lr� ADDRESS CITY2IP PHONE r <br /> �RE� f�oL �i�tu-� � 2S�z `LJ�...�.E{zAvE. , E.,Eg� 9'0201 ZSB��L-1�z <br /> TENA NAME CONTACTFORPEHMIT PHONE�Zs• Zsz• ti�53 <br /> (ZY�a,.l ��..�a�ttavs <br /> � ��J E 2AiZA2c�1,-t�c..N e�rna�CFHa� 12A4ct!-r <br /> ��.GI_.lr.� �yTE £sFS C..LG -7 �f <br /> CONTR,LICENSE# � / � �S/ ' !Z I O <br /> Po a�x �2�a A�ru, o,J a� �a2z�s <br /> IISE OF BUILDING HEA�T SOUR—CE� CONTRACT PRICE OF WORK <br /> -'/�'TF�Id.� Yq"f�l —J-'�'- —"""—Other c�' 7(� DOD <br /> WORK DESCRIPTIOtI <br /> Go�SgiY1.JC�T�o►J 6iF �0.� G�ti1GRC rC. '�7TaR-NnW rh'�VE�1i"�o���L'� <br /> W� ��• C�s-r Ca�.1C. �c..�NtL L-,�� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF�IXTURE OR ITEM <br /> _ Toile� A/C-airhandlingunils <br /> _ Bathtub Forced air systems <br /> _ Lavatory iwash 6asin) Gas piping <br /> _ Shower Waler heater <br /> _ Kitchen sink 8 disposal Gas lireplace <br /> _ Dishwasher Gas range <br /> _ Clolhes wesher Clothes dryer <br /> _ Water heater Range hood <br /> _ Sink(serviceibar/mop/etc.) Exhaust fan <br /> _ Backflow prevenler Heal pump <br /> _ Urinal Unit healer <br /> _ Drinking Fountain Boiler <br /> _ Floordrain Refrigeration <br /> _ Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETi LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be Irue and correct. All provisions ol laws and <br /> ordinaces governinq Ihis type of work will be complied with whether specified herein or not.The granting of a permit does not presurne <br /> to give au�hority lo viola�e or cancel ihe provision of any other slate or local law regula�ing consiruction or ihe perlormance of <br /> consiru ' n.That I am Ihor' y Ihe owner ol�his property to perlorm ihe work tor which application is made and I comply wilh ihe <br /> Stal o Irac�ors Law 1 .2 296.20 <br /> ig e ner/Contraclor/Aul o ' gen� Da �/ <br /> � <br />