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( � <br /> PtRMIT APPLICATI�N ; <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 ' <br /> 425-257-8810— FAX 425-257-8857—wuvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM x �DI ' 00� <br /> SITE ADDRESS PARCEL T/UC I.D./ PERMI7/ <br /> 3 /� ,S o _ c <br /> LEGA LOT NO. BLOCK TRACT OR SUBDMSION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��i�a« G,�,s-r 730� yt��o�..J.� ,r.�,rysr.��re yzs'z.�_s- <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �llx �IZZ-�'`-TO � E'�ia�Z3�• 5�3� �. <br /> CONTR.LICENSE N �, <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �/—p(�x _Electric Gas_Other '� � <br /> WORK DESCRIPTION <br /> �I�� � � � " � <br /> PLUMBING MECHANICAL <br /> NO. TYP�OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling uni�s <br /> ' Bathtub � Forced air systems <br /> Lavatory(wash basin) � � l� Gas piping <br /> � Shower �� f Z Walerheater A � /�-� <br /> �_ Kitchen sink&disposai � _ Gas fireplace /� � I^� <br /> ,3 Dishwasher � Gas range /'�� � / <br /> -��-� Clothes washer � � Clothos dryer ,r� <br /> "\+i Waler healer Range hood ��.._ <br /> Sink(service/bar/mop/olc.) � Exhaust fan � { � <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> _ Drinkiny Fountain Boiler � <br /> _ Floordrain Refrigeration <br /> Greaso trep Woodstove I z( <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT L^vGwi i.".IES TA%CODE IS J105 <br /> i hereby ceritity that I havo read and examined this applicution and know the same to be true and cortect. All provisions of laws and <br /> ordinaces c�ovemine�this type of work will be complied with whether specified herein or noL The granling of a pertnil does not presume <br /> to give authorily to violate or cancel the provision o(any other state or Iocai law regulating consWction or the pedormance oi <br /> construction.That I am aut orized by the owner of this property to perform the work for which application is made and I wmply with the <br /> Sta Contraclors Law 1 7 RCW and 296.200 WAC. <br /> + ' < <br /> JZ�Cr��i�� ��, C.r� �•/� D '7 <br /> Signature o(OwnedConir c /Authorized Agenl Date <br />