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i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> �p"� �C'C� ��_S U ; 32Q0 CEDAR STREET, EVERETT, WA 98201 <br /> � 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> Rl APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SITE A�RESS S� n PARCEL TA%I.D.q �€RMIT ri <br /> / l�� G� � s' •� _�`k� -Croj_ oc7 (",G'�'�J -13 <br /> IEGAL LOTNO. BLOCK 7T2ACT� �� (� <br /> DESC. � pY� <br /> OWNER A�DRE55 CITYTP PHONE <br /> DYti41d�, f�(��,,-�3 _T�r= �'n3,i�r ) /c �u c��z rf�c y�1=<'_Sz�T6r�' <br /> TENAN NAME I �ONTACTFORPERMIT - PHONE <br /> `/ 1���G��-�y �izf=yzz -�6�f' <br /> CONTRACTOR U�/��4S`�( (y��,�VS �I7�ADf ...55 CITY2IP PHONE <br /> CONTR.LICENSE q T�� <br /> Pv p°k 7�� r��- C�. Z `Ts-�,,�;- Z Sl.'Ji f y' <br /> USE OF BUILDING HEAT SOURCF CONTRACT PRICE OF WORK <br /> {��P �G� _ ,�Gas_Other Q <br /> Electric � �� U c�J <br /> WORK DESCRIPTION <br /> `�w .��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR IlEM NO. TYPE OF FIxTURE OR IlEM <br /> Toilet AIC-air handling units <br /> �(_ Bathtub Z Forced 2ir systems <br /> <<! Lavatory(v.ash basin) � Gas qping <br /> Shower y Waterheater <br /> L Vtitchen sink 8 disposal �� Gas fireplaca <br /> � Dishvssher Gas range <br /> Z- Clotheswasher Clothesdryer <br /> Laundry iray � Range hood <br /> _ Sink(servicelbadmop/etc.) � Exhauslfan <br /> Dackflow preventer Heat pump <br /> Urinal UnR heater <br /> Drinking Fountain poiler <br /> Floor drain Refigeration <br /> Grease Uap Woodstove <br /> Rooi drains Other <br /> Ofher <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerilify ihal I have road and ezamined this applicaUon and know tha same to be We and cortect AII provisions of laws and <br /> ordinaces goveming this type ot work will be complied H�th vfiether spedfied herein or not The granNng of a permit does not presume <br /> to give au�horiry to violate or cancel tlie provision of any eiher state or local law regulating conr,Wction or the peAormanca of <br /> construction. That I am authonzed by the owner of ihis property M pedorm the vrork for which application is made and I comply with ihe <br /> State Contradors Law 1827 RCW and 2962CA WAC. <br /> � , U � <br /> �_— %- z 3 E, <br /> Sig re of � ertContractodAu�ori d Agent Date �'�- \ <br /> /� <br />