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, <br /> -- —� — <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT', WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FR1�M 8 AM TO 4 PM �b_� a � �O <br /> SITE ADDRES°. PARCEL TAX I.D.# PERMIT q <br /> G����'�n,o�-t� ��-�� <br /> IEGA LOT NG. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> (��1 t�J rr�,� 1� �'zti � v� 5�,� �� �:�Go�-e �o� -�l S�/- S 3 `1 <br /> TENANT NAME I CONTACT FOR PERMIT PFiONE <br /> S��'�-- E•MAIL <br /> ' QIUN�� � <br /> CONTR.LICENSE M <br /> USE OF BUILDING �• ' HEAT SOURCE CONTRACT PRICE OF WORK <br /> � �)���� f <br /> ���'�'��U L.,,� _Electric __Gas_Other �S, Q(� <br /> WORK DESCRIPTION <br /> l�� �'G�Yr1�C.e �(� �vv�o �(.sS� o (� �w.,s� — `D�c�u,�a,�,( <br /> Y�M.t.oc�-� ?S�.�v�s �Cc.�'�'i �ooh.-� <br /> PLU BING MECHANICAI <br /> N0. TYPE UF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � Toilet _ AIC—air handling unils � <br /> J_ Bathtub _ Forced air systems <br /> ��_ Lavalory(wash basin) Gas piping <br /> _� Shower � Weter heater <br /> � Kitchen sink&disposal _ Gas fireplace <br /> J_ Dishwasher Gasrange <br /> J_ Clolh=s washer ,L Clothes dryer <br /> Waterheater Range hood <br /> Sink(scrvicc/badmop/etc.) ,� Exhaus�fao <br /> �ackfiow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease Uap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cedify Ihat I have mad and examined Ihis application and know�he same to be true and correct All provisions oi laws and <br /> ordinances goveming this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> lo give authority lo violate or cancel ihe provision o(any o�her state or loral Iaw regulating consiruclion or the performance of <br /> consROction. That I am authorized�y the owner of this property to perlorm the work for which application is made and I comply with the <br /> Stale Contraclors Law 1827 RCVy�and 296200 WAC. <br /> � <br /> '"� �/�1�� /7 '7�t��1 h <br /> , - , <br /> Sig eture t OwnedContfac o Authonzed Agent �l Date <br /> tJ <br /> I <br />