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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-881 p- FAX 425-257-8857-www,,everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SI7E ADDRESS <br /> �G\ � ���� �� PARCEl7AXI.D.i1 PERMI7p / <br /> LEGA LOT NO. BLOCK �G 7�/ 'D D 4c� <br /> DESC, iRACi <br /> OWNER <br /> ADDRESS CITY2IP � <br /> PHONE .i 5 Z - u,Z � <br /> �'ev.� G�d r.�t, <br /> TENANi NAME 1 � '�'`� 1 " � r� t.�- S,b 2L <br /> I CONTACTFORPERMIT <br /> PHONE <br /> CONiRACTOR <br /> Kc.lw�e� f{pyt•,,,� ADDRESS <br /> ��Tr2�P PHONE ';�,�� <br /> CON7R.LICENSE# 4�" �" `��'�-"'^-� �-`�e�t n` <br /> l�A l,�+,. S�g . o ( G,L <br /> G lr-iE o G�v P 9 q ���� <br /> USE OF BUILDING , �n"h� "^, �= c 2 'r O <br /> HEAT SOURCE CONTRACT PRICE OF WpRK <br /> Electric Gas�Other p� (. ce <br /> WORK DESCRIPTION -- S� �{ �. <br /> l�p l�C�L 1 � \c.2 -�x 1', kR. u; \ <br /> L�c� « r <br /> PLUMBING <br /> NO. TYpE OF FIXiURE OR ITEM M�CHANICAL <br /> N0. TYFE OF FIXTURE OR ITEM <br /> _ Toilet <br /> _ Bath�ub � A/C-air hanCiing unils <br /> _ Lavatory(wash basin) _ Forced air systems <br /> _ Shower _ Gas piping <br /> _ Kilchen sink 8 disposal _ Water heater <br /> __ Dishwasher _ Gas fireplaco <br /> _ Clolhes washer _ Gas range <br /> ._ Waler healer _ Clothes dryer <br /> __ Sink (service/bar/mopletc.) _ Range hood <br /> ,_ Backflow preventer _ Exhaust fan <br /> _ Urinal _ Heat pump <br /> _ Drinking Fountain _ Unit heater <br /> _ Floor dr„in �_ Boiler <br /> _. Gease frap _ Refrigeration <br /> _ Roof Crains 1h'oodstove <br /> _ Other_�_ __ Other <br /> _� <br /> --�— — - <br /> CITY OF EVERETT LOCAL SALES TAX COpE IS 3105 <br /> I hereby ceritify that I have read and examined Ihis application and know the same to be true and correct. Ail provisions of laws and <br /> ordinaces governing lhis type of work will be complied with whether specitied herein or noL The granting of a permi(does not presum a <br /> to give authority to violate or cancel Ihe provision of any oiher slate or local law regulating construction or the pedormance oi <br /> consiruction.That I am authorized by tho owner o1 this property lo perform Ihe wurk}or which application is made and I comply with the <br /> S�al�Coniraclors Law 18.27 RCW acd 2g�.200 WAC. <br /> Signal���Con�tracto Authonzed Agent I � �� �� <br /> Dale <br /> -- —�—_— <br />