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PERII!!IT APPLICATION <br /> CITY OF EVERETT P�RMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 4:�5-257-8857-wwv✓.everettwa.org <br /> APPLICAl'IONS ACE ACCEPTED FROM 8 AM TO 4 PM a � I �{ �Oa <br /> S il� ESS LE `� � ��4b ELTAf^`�����(�RMG'�� �- I� <br /> LEGAL LOiNO. BLOCK TFiACTORSUB0IVISION# A <br /> DESC. � D-"� Guj e � /� D <br /> OWNER AODRESS CITY2IP PHONE <br /> U,1 (�R-�G►`l �L2Q�1 �Sb �4���. ��2�, �1�,�03 <br /> TENANT N�ME CONTACT FOR PERMIT PHOIJE '. <br /> L.�a._+NEI�— O�-171v�=-1�-- E-MAI'. <br /> CONTRAC OR 1 ADDR SS �� � �P �� � � I <br /> �,�. P�.9\tJ � S-t'rL1L � U^� �oS�O �Z"'� St St= 5u;o�an���• �t�bZ�O i <br /> CONTR.LICENSE p L''L�- 3��• � 1 � II <br /> �3Q-uir,1P� ��Z QL I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �-����_�� _Eleciric _Gas_Olher � a S �,� <br /> WOR�.(IIESCRIPTION '� n.�. `� '���lC�j�L <br /> �r� <br /> PLUMBING MECHANICAL I <br /> NO. TYPE Of-FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM { <br /> �� — __ i <br /> Toilet NC-air handling units <br /> � k Bathlub __ Forced air systems <br /> 1� Lavatory(wash basin) _ Gas piping <br /> ,_ Shower __ Waterheater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washe� _ Clothes dryer <br /> Water heater _ Range hood <br /> Sink(service/badmop/e�c.) _ Exhaus�fan <br /> Back(low prevenler _ Heat pump <br /> Urinal _ Unit heater <br /> _ Drinking Fo�ntain _ Boiler <br /> Floordrain _ Refrigeration <br /> Greasa trap _ Woodstove <br /> = Root drains — — I = Other <br /> Other _ — — <br /> CITY OF EVEFETT LOCAL SALES TA%COUE IS 3105 <br /> I hereby ceritify that I have read and exami�ied ihis application and know Ihe same Io be true and correct. All provisio�s of laws and <br /> ordinaces goveming lhis rype o!worP.will te complied Kith whether specified herein or noL The granting ot a permit c� es not presume <br /> to give aulhority to violate or cancel thE provision of any other�tate or local law regulating constmction or the pertormance ot <br /> consiruction.That i am authorized by ihe nwner of ihis property to per(orm Ihe work(or which application is made and I comply with the <br /> Stale Contr tors Law 18.2�RCW and 256.200 WAC. <br /> { �� -lC '�� <br /> Sign u e f 0 ed o racrorlAuthonzed Agent Date <br /> :,.. _ •..... .. ,. ,..... .: ... . . . . <br /> . . . . .._ . . . . .. . . . . . .. _. . <br /> _. <br />� . � . �!�. . . . <br />