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PEkIlr'fIT APPLIC.A�i IO�u <br /> CITY OF FVER�TZ PFRMIT SERVICE� <br /> 320� CED,4R STREET, EVERETf, WA 98201 <br /> 425-257-8810— F.�JC 42s-257-8857—www.evereftwa.org <br /> J^/)� c�^ APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �' Li.1 � J� � a� U <br /> SITE ADD ESS J PARCEL TAX I.U.# I PERMIT# <br /> � ., •� '�rl � '/u' S'� � ' C�c�� ( - �� -ss <br /> LEGAL LOTNO. BLOCK TRACT ,J/1�- /��/ /� <br /> DESC. 3 �c� �lk� GV ✓ I.l�lU�Lr`' . <br /> OWNER AD�RESS CITYIZIP PHONE <br /> ��zu��-�����/�_ �G7�/ G1��',�� /.(/°r�- /��r/��/�r� y2�-3�5=y�Gl <br /> TENANT NAME I CONTACT FOR PERhtIT PHONE <br /> � . ' , ' �I�'vr�/C� �/�f 7/S 1/C�;?�• �,�� <br /> CONTRACTOR '/ ,i�J� ADDRESS �JC/ITYIZIP /� PHONE <br /> Pi( /�ei �G7� U'�✓�fi(� ���%!�f'G" �' �f'G��. <br /> CONTR.LICENSEN �j�'//v��� , k '�� .!� t• � ����// �/i/jj <br /> �i � � (/�!7 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���� _Eleclric ��Gas_Other ����/�/� <br /> —� — <br /> WORK DESCRIP'fION <br /> /l,,-%r�' S�y•/ %u,/ /�r`�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIX'fURE OR ITEM N0. 7YPE OF FIXTURE .<ITEM <br /> 3 Toilet � ' A/C-air handling units <br /> •,t Bathtub' ' I Forced air systems <br /> � Lavalory(wash basin) I . � Gas piping <br /> ,�n� Shower � / Waler healer <br /> _L Kilchen sink&disposal _L Gas fireplace <br /> ( Dishwasher Gasrange <br /> % Clolhes washer � Clothes dryer <br /> _�'_ Water healer Range hood <br /> Sink(servicelbar/mop/etc.) � Exhaust fan ���� <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> � = Drinking Fcuntain = Boiler <br /> Floor drain Refrigeration <br /> M, _ Grease trap = VVoodstove — <br /> Roo(drains Other <br /> i: Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhal I have read and examined this application and know the same to be true and correcL All provisions of laws and <br /> ordinaces governing this type of�vork will i,e complied with whether specified herein or noL The granting of a permit does not presume <br /> lo give aul',ority to violate or cancel the provision o(any other state or local law regulating construction or the performance of <br /> construclion.That I am aulhorized by the owner of this property to perform the work tor which applicalion is made and I comply with the <br /> State C rtlydCtb"1'�C N 12.27 RCW and 29G.200 WAC. <br /> /�C ��-��.__� /< �� <br /> Si'gnaWre of cr7Contractor/Authonzed Agent Dale t/ <br /> �L <br />