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J�r�`1'�'�, <br />SITE ADDFESSL <br />LEuAL LO1"N0. <br />DESC. <br />OWNER <br />TEN'NTNAME <br />1. <br />�� <br />PERMIT APPLICATION <br />CITY OF E:VERE'TT PERNtIT SERVICES <br />3200 CEDAR STREE��, EVEFiETT, WA 9&201 ��_ 1 b ��5 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED F ROM 8 AM TO 4 PM <br />� , PARCEi. TAX L�. # <br />� �, <br />BLOCK TRACT� �,, ,�'j : - �� <br />. I-�/ . � � i�� <br />ADO ESS � / CINIZIP <br />� a� �� 3 /f esuw. � �.c�2 �-u <br />CON ACT FOR P RMIT <br />� )t �./�� <br />a . ��i�� � V�E-i\.1'il .�/ . � <br />CO TRACTOR �NC��/� / '! <br />� u� l,d <br />CONTR.I.ICENSEfI [( (� / GG g�Q <br />�T! L <br />USE OF BUILDING <br />WQRK DESCRIPTION <br />� r [�� <br />CITYlZIP <br />��� � . . <br />r'���_���:-% <br />PERMII' # <br />-- ` — / <br />��� .1- ' �7' Ci � <br />PHONE (�, 2 � <br />o, <br />PHONE <br />. � 6 � - �� <br />PHONE <br />,.. <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric ��Gas _ Olher �/� � Q�� � <br />�t� ,. <br />�,'/J '�i � /�% 7 <br />ir' �-, ��.,�, G�R/-�G� �' 3A �f. <br />NO. I TYPE OF FIXTURE OR ITEM <br />.3 Toilet <br />�_ Bathlub <br />•" � Lavalory (wash 6asin) <br />J � <br />�_„_ Shower <br />` � Kitchen sink & disposal <br />1 Dishwasher <br />�Cloihes washer <br />Laundry Uay <br />Sink (service/bar/mop/etc.) <br />Backflow prevcnter <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />�T L�vY�. <br />1�0. I T.'PE OF FIXTURE OR ITEM <br />AlC — air handling unils <br />� Forced air syslems <br />�Gas piping <br />�_ Water heater <br />/ Gas fireplace <br />� Gas range <br />/ Clothes dryer <br />' Range hood <br />�'� Exhzusl tan <br />— Heal pump <br />— Unit heater <br />— Boiler <br />— Retrigeration <br />— Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerili(y lh2t I have read and examined lhis application and know lhe same to be irue and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with wh2lher sper,iAed herein or not. The grantiny of a permit does no! presume <br />lo give aulhorily to violale or cancel lhe orovision of any other slate or local law regulating construction or lhe periormance of <br />construction. That I am aulhorized by the owner of Ihis property lo pedorm the work for which application is mad� and I comply wi:h the <br />State ¢ortractors��L `v 7827 RCW and 296.200 WAC. <br />� /,r, (. _ - I�O�� % ,� <br />(. <br />