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P�KMIT APPLICATION <br /> CITY OF EVER�TT PERMIT SERVICES '= " <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM T04 PM ��� C��`,1 � 'C j3 <br /> SITE ADDRESS PARCEL TAX I.D.# PF�RM T# � <br /> I 'L L 4W • � �. �OS S U <br /> LEGAL LOT NO. BLOCK TRACT � C�- ,, �.-- <br /> DESC. "� .� � �' �� <br /> OWNE r ADDRESS CITYIZIP PHONE <br /> nui.�ey�eval�✓a��ui� Ckx�t��'aelar5 po 6pK ?�l G►�v�le�lh w� 31ad�41=��'S� <br /> �1 XZSZ <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> , :. ;,: �a Jo��--�-� . . 3�o-_�q i -7.:,s.� .�: <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> v�.w, C�eale.ral Fvav�ial�Cot�•waCbr� �� 4�-201 4Ycw�e.(�c�ll5 �+ _ .��p�lnG 1��5� <br /> �1nRv i�ln(SE!-(� � �i'yv - o C.o � '; .; c qg�Z' , , . <br /> .,.-�,._-,_� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S I IJ(aL� F/��147 Q�51b�N� —Electric �,Gas_Other <br /> WORK DESCRIPTION <br /> �a��r�+ei ��ql�.�a��u1y, e,��len�-s <br /> I� `;�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE Of FIxTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Z Toilel A/C—air handling unils <br /> 2 Bathlub �_ Forced air systems <br /> � Lavatory(wash basin) � Gas piping <br /> " Shower �_ VVater healer <br /> � Kilchen sink&disposal �_ Gas fireplaco <br /> � Dishwasher Gas range <br /> � Clothes washer _L Clothes dryer <br /> �' Waler heater �, Range hood <br /> Sink(service/badmop/etc.) � Exhausl(an <br /> BackOow provenler Heat pump <br /> Urinal Unil heatcr <br /> Drinkinp Fountain Boiler <br /> _ Fbordrain Refric�eralion � <br /> Grease lrap Woodslove <br /> Roof drains Other <br /> = Other E I <br /> CITY OF EVERETT LOCAL SALES TAX CODE�S 3105 <br /> I hereby crritify thal I have read and examined ihis application and know Ihe same lo be lrue and correct. All provisions of laws and <br /> ordinaces governing this typo o(work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authurily lo violale or cancel the provision ol any other stale or local law regulaling conslruction or the performance of <br /> conslruclion.That I am authorized by lhe owner of Ihis properly lo perform the work for which application is made and 1 comply wilh lhe <br /> State Contradors Law 18.27 RCW and 29�.200 WAC. <br /> � <br /> - f�-�' i�Z !%�- '' �-- 3-z � _ u � <br /> Signalure�tf vned onlraclor/Authonzed Ac�ent Date 1 <br /> :. <br /> la <br />