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PEFt�IlIT APPLICATION <br /> CITY OF' EVEREIT PER�VIIT SLFiViCES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.x PERMIT# <br /> /oi � 39' �� 57 ooH7o� oo2oZloo ' ��ri(�,-cK-�� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> uEsc. 21-22-Z3-2'� 2 /-�Ew�77 t .!-� PrD � <br /> OWNER ADURESS CRY21P PMONE <br /> 7'�� ¢ S�S�a,� �� �oS loll 39�N S7- fv�,e�� 9?5 �830710 <br /> TENANTNAME CONTACTFORPERMR PHONE(�Zc� -7�'Z']' L�S9� <br /> I J���/JA�O/J ��V�F / 1'� E-MAIL✓�QW�(�A�f'CtnlSeAy��'PSi £L <br /> ��F� w��cqu�l,w� 2z5 a�vo2sotil �3�d� �v�2�77 <br /> CONTR.LICENSEp ��FE27 7do�+-+aS B✓��Di.�/G ��u.toDE�in�C <br /> CGDI - TEFF £TBODSPE F�P 9/i3���o <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PRICE OF WORK <br /> �ES�O:����L _Electric _Gas_Olher �✓?9�Q(J� � <br /> WORK DESCRIPTION ��57ALL s-�E� pi�E # 7"iK+aE2 L�*�G�"�G 2tr��N��� wa�L <br /> AGPK• g0 FT• LO�1G X �IFT. 7d 8FT T/1!� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl%TURE OR ITEM NO. TYPE OF FIXTURE OR REM <br /> Toilet A!C-air handling uniLs <br /> Bathtub Forced air systems <br /> Lava�oiy(wash basin) _ Gas piping <br /> Shower Wator heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ _ Gasrange <br /> Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) _ Ezhausl�an <br /> Backllow preventer __ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Relrigeration e <br /> Greasetrap _ Woodstove <br /> Fioof drains _ Other <br /> i <br /> Other — I <br /> CfTY OF EVEREIT LOCAL SALES TN(COOE IS 3105 <br /> I hereby ceritify that I have read and examined Ihis applica�ion and know the same lo be truo and correcl. All provisions ol laws 2nd <br /> ordinaces goveming this type of work will be complied with whether specilied herein or not.Tho granting of a permit does not presume <br /> to give aulhoriry to violate or cancel the provision ol any other state or local law�egulating consvudion or the pedormance of <br /> construction.That I am authorized by ihe owner ol ihis property to perform�he work lor which application is made and I comply with�he <br /> State CoNractors Law 18.27 RCW and 296.200 WAC. <br /> i nawre or ner/ omractor ut onzed ent p ate� �� ? <br /> L'� <br />