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PERMIT APPLICATION <br /> CITY OF EVERIETT PERMIT SERVICES <br /> 3200 CECAR STREET, EVIRETT, WA 9820t "Jr—/2 J /' <br /> 425-257-8819— FAX 425-257-8857—www.everetlwa.org Lf S�' <br /> I�Z� APPLICATIONS ARE ACCERTED FROM B AM TO 4 PM� � � <br /> � J-+ / <br /> SITEADDRESS � ' PARCELTAX D.MxSN`��lXJu� PERMITX <br /> � Met�,�� n�e.. }� � 2 - � <br /> LEGAL LOT BLOC!( TRACT i+/nJ /Xn /} � <br /> DESC. � � / V �'�— <br /> OWNER �� ADDRESS ��,� � �` CITYfiIP PHONEU z� ! S 5 <br /> uSw' <br /> `rr�•^ CG� �, \-1 ,: � _�: ,� , z a � � 1� � ��t,� z <br /> TENANT NAME (4.-]-GG' I CONTACT FOR PERMIT PXONE <br /> � • • � Je(�� I-��b �t ; ' 41T rs�� �y�. • . . , .� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> �n.-.� a .A1 . qV��t , � • � � • <br /> CONTR.UCENSE# ���� ;=•, i 1 .� � `� -_i L �- , � •�• r � � � ' ' <br /> USE OF BUILDING MEAT SOURCE CONTRACT PRICE OF WORK <br /> (� -. �l _Ele.tric _Gas�Othor ���7 � UU�� A�{. <br /> „ l <br /> WORK DESCRIPTION �7J�7�J <br /> '�:- �1�,� GtS� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � Toilel WC-air handling units <br /> 7 8athlub � Forced air syslr.ms <br /> � Lavatory(wasli basin) � Gas piping <br /> Shower � Water heater <br /> 1 Kilchen sink&disposal 1 Gas firep!2ce <br /> � Dishwasher � Gasrang� <br /> Clolhes washer � Clothes dryer <br /> i Watcr healer 1 Range hond <br /> Sink (s�rvice/barlmop/etc.) � Exhaustian <br /> Backflcw preventer Heat pump <br /> Urinal Unit heater <br /> Drinking FouNain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodslove <br /> Roof drains ^ Other <br /> Other <br /> CITY OF FVERETT LGCAL SALES TAX CODE IS 3105 <br /> 1 hereby ceritify thal I have read and examined this applicaliun and know the same to be We and wrred. All provisions of laws and <br /> ordinaces governing this ty,e of work will be complied wilh whether specified herein or n� The granting of a permit does not presumc <br /> to give aulhority to violate or cancel the provision of any olher stale or Iecal lae�regulaling construction or the periormance o( <br /> wnslruction.That 1 e m authorized by ihe ownur of lhis prcpeRy to pedo�m lhe v,erk for which application is made and I comply with the <br /> Slale Contractors L;,�v 18.2,7 RCW and 29G.200 WAC. <br /> � `�' � � J- <br /> Signatura of Owner%Conlra�t- orlAu�h�nz Agent Dale <br /> ��-� <br />