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F :RMIT APPLICATI N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8657—www.everettwa.org <br /> ApPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT# <br /> �lOOy' GbQ <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER / ADDRESS CITY2IP PHONE <br /> {�Gi w� �/�'�Y ' a—. ��,/7 ✓ �ti � IJ%c�'w �jv1, /�.?OS ��S 3S� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE G� � <br /> / � E•MAIL <br /> L`OFlgkAl:fib 2� nwne8$ � <br /> �l/P.. �'/�,��i;,�5 Gol.3 RJ.,�. �,'��� rP� S�a��:,%sG 1.�53"G�- �i <br /> CONTR. LICENSE# <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Elec�ric Gas_Olher <br /> WORK DESCRIPTION /r' /� // <br /> G'�l 5 -/ /'u�M I'/O !Jf` � C✓✓ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> Toilel _ NC-air handling unils <br /> Bathtub _ Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Waler healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clolhes dryer <br /> Water heater Range hood <br /> Sink (service/barlmop/etcJ _ Exhausl fan <br /> Backllow preventer _ Heat pump <br /> Urinal _ Unit healer <br /> _ Drinking Founlain _ Boiler <br /> Floor drain _ Refrigeratio�i <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify ihat I have read and examined this application and know lhe same lo be Irue and correct. Ail provisions oi laws and <br /> or�inances goveming this rype of work will be complied with whelher specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other slate or local law regulating consWclion or the pertormance of <br /> conslruclion. That I am aulhorized by the owner o(this property to periorm the work for which application is made and I comply with the <br /> Stale Contraclo�s Law 1827�R �d 296.200 WAC. <br /> ,J-7r�� ��� 'C C-Lr ��L' % � <br /> Signature of OwnedContraclodAulhorized Agen� Dale <br />