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. i <br /> PERI11�1'�' APPLICATI�N <br /> CITY OF EVERETT PERMIT �ERV9CES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> I APPLICATIUNS ARE ACCEPTED FROM 8 AM TO 4 PM �a - a a - io <br /> SITEADDRESS SVlTE 34� PARCELTAXI.D.# PERMIT# <br /> I 5no .TNnvsT �r sr �v �tt �ez z� - 0�01 -� - aaa - oo ���/2 n� <br /> LEGA LOTNO. BLOCK 'fRACTORSUBDIVISIONi{ <br /> DESC. <br /> ADDRESS CINILP PHONE <br /> T�NT - G�rtDiuG 711 IDO TNfT �YIYG�'/' 9Sza¢ 3535 %137 <br /> �b(E �y <br /> TENANTNAME CONTACTFORPERMIT PHONE ZO6' �dI yZ�s <br /> 5H�'i!/A -1' D1t�IP �✓A�{ I �R✓j�A G��DN�lL E.�,�a� �avrR (�qms�ia, <br /> � � ��tvm�—�xsa��— <br /> -r�N�Nr <br /> CONTR.LICENSE# <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK <br /> GYw�NPr5 Tl cs G�NT��Z I _Eler.tric �Gas_Other I ' �rd� � ��Q <br /> � <br /> WORK DESCRIPTION <br /> � �� <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURL•OR I7EM NO. TYPE OF FIXNRE OR ITEM <br /> Toilel _ NC—airhandlingunits <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) __ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink K disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Clothes dryer <br /> Waler heater _ Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust fan <br /> BackAow prevenler _ Heat�.ump �� <br /> Urinal _ Unit heater I <br /> _ Drinking Fountain _ Boiler <br /> Floor drain _ Rehigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERE7T LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certify that I have read and examined this appliration and know the same to be lrue and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authonty to violate or cancel the provision of any other state or local law regulating conslrudion or the peiformance of <br /> construction.That I am aulhorized by the ovrier of this property lo perform the work for which application is made and I comply with the <br /> State Contraclors Law 1 27 RCW and 296200 WAC. <br /> (�1� �� l„ ��.�ti� /Z-/�-/� <br /> SignaWra.�f� edContrecto/ thonzed Age t Date �/� <br />