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P�RMIT APPLIC�►`TIC�N � <br /> CITY OF EVERET�' PERMIT SERVICES '� <br /> 3200 CEDAR STREET, EVERElT, WA 98201 ! <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org p� ��•7 _��� -7 <br /> r <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TC 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> � <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# �� �'� <br /> ( � � r�� S7�L l'1� � �{ � � c� a .2 0 :� � � ( —�l '-� �. <br /> LEGAL LOT NO. BLOCK TRACT _ � <br /> OWNER � ADDRE 5� ✓� CITY/ZIP PHONE I <br /> � <br /> l�¢ ) ,��Cz� �c ,'� i/� `/i0 � .:� l� � �z�� �a>-.�3ssz� y <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> � . % <br /> Sj�e , �c7-�y�/�� '. �� . �.�y:'�3a �-�� � <br /> CONTRACTOR p �� GCC ADDRE55 CITY2IP PHONE <br /> ' Y � <br /> ��90 i�, . <br /> CONTR.LICENSE# �� �• �• �•• ��� �. ' <br /> � ,/ <br /> f'.�/i,f-C< Ol�2 Ld f//' ��il� /�/d �ir,.� ���4���3 G �-Ly . 23 5 � 2 2 `� <br /> USE OF BUILDING I � — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��,�4 ��,�,�� � � i_, Eleciric �Gas Other �� �) ��J <br /> WORK DESGRIPTION <br /> /���v ��4� ��-o�� <br /> /�—/ <br /> PLUMBING MECHANICF:L <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 Toilet A/C—air handling units <br /> �'�,� Bathtub / Forced air systems <br /> 'J Lavatory (wash basin) � Gas piping <br /> � Shower � Water heater <br /> / Kitchen sink&disposal _L Gas freplace <br /> % Dishwasher / Gas range <br /> � Clothes washer � Clothes dryer <br /> _ Laundr�tray % Range hood <br /> Sink(service/badmop/etc.) � Gxhaust fan <br /> � B2ckflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain � Boiler <br /> Floor drai� � r efrigeretion <br /> Grease trzp Wncdstove <br /> Roof drains Other_ <br /> Other <br /> I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> II hereby ceritify that I have read and examined this anplication and know the same to be true and correct. All provisions of laws and i <br /> Iortlinaces yoverning this type of work will be complizd �vilh whether specified herein or not.The gran:ing of a oermit does not presume I <br /> to give authonty to violate or cancel lhe provision of any other state o�local law regulating conswction or the performance of � <br /> consWction. That I am authorized by the owner of this property to perfurm the work for which application is made and I comply with the <br /> State Co r�ctors La 18.27 R/C�W and 296.200 WAC. <br /> ���� " `/�J,� 7- �-�s ' <br /> Si9nature of OwnedContract� or/Authonzed Agent Date '! <br /> �/'�' �I <br />