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_ --1 <br /> - P�r�MIT APPLICATIO�J <br /> ���.; CITY OF EVERE7T PERMIT SERVIrES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> ` i� 425-257-8810 — FAX 425-257-8857—www.everettwa.org i I <br />'�S�ti•� � � � ��1�_� .�;��n <br /> , � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - D681T 8 CREDIT CARDS ARE NOT ACCEPTED <br />,u <br /> ! PERMIT� <br />�,�k � SITE ADDRESS PARCEL TAX I.D.# <br /> `¢ � � � � �� � �� T _ 3 /� �oS 30� �600u LG >G2 —U��� <br />� i /� <br /> LEGAL LOT N0. BLOCK TRACT,- <br /> � . � ,' DESC. �_�c1�,��.Xxi <br /> t' : 1 ' �� - - CITYlZIP PHONE <br /> OW4ER AO�RESS <br /> i �a g ��'-3�fi-4�6 �`f <br /> , 't+ / / p // � i <br /> j•I � ,����C /n�(.lTs2�C L c�. �' �� G' ,/,o�X� �/U C�����f C,l a �,5-Z 3 G I <br /> ';'tl-"����- ' -i Et!ANT NAME CONTACT FOJt PERMIT Zr H�32 -0 5 7 <br /> /.i.U=N����:ti,, 4� 4� � <br /> ;;I.;h:; j Twv� )7-Qo�, 3c � 9�9- �Y3? <br /> ti� I � ' <br /> , � CONTRA(1TOR ADDRESS' CITY2IP PHONE <br /> �ry�� !'C`�J /�c=-z•lr C�'.:�.l L.L C <br /> � i 3'GG -J 4�/ -�/GGK <br />�� �' I CONTR.L!CENSE# "� � � ,o i �- <br /> � 2J <br /> � �� O r � G'/).� GG��.�h�Cd.R �� ! <br /> s I �,�/%C� .j` IO 2 G l; il Y/ e <br />}M{VF'.'.. <br /> USE OF[iUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �t„_ �� �- � ' � �% Electric K Gas_Other / � � <br /> -�' z 6->•�c� ���c�L.-,-� — � (/�fJ C� _ <br /> .' -� <br /> i <br /> WORK DESCRIPTION <br /> C-, �� ��- <br /> z)��Q�G'Z�cGeL,r., G%/ /�.�:J . �L%u� <br /> (1 <br /> PLUMBING MECHANICAL <br /> Np, IYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 Toilet A/C-ai�handling units <br /> 2 Bathtub � Forced air systerns <br /> � Lavatory (wash basin) �� Gas piping ' <br /> Shower � VVater heater � <br /> � Kitchen sink 8 disposal � Gas tireplace I <br /> / D:shwasher Gas range <br /> � I 1_ Clothes washer / Ciothes d�er <br /> � Laundry tr3y ( Range hood <br /> Sink(service/bar/mop/etc:) Exhaust fan <br />� . � Backflow preventer = Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain ___ Boiler <br /> I T Floor drain _ Refrigeration I <br /> ' � Grease trap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> I <br /> ' CITY OF EVERETT LOCAL SALES SAX CODE IS 9105 I <br /> ' I hereby ceriti(y that I have read and examined lhis application and k,iow the same to be true and correct Ali provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not.The grantin� of a permit does not presume <br /> � to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> � construction. That I am authorized by the owner of Ihis property to perform the work for which application is made and I comply wi[h the <br /> i Slate Contrac' rs Law 18.27 RCW and 296.200 WAC. il <br /> 7 <br /> � ,� "�z��.i�-vZ` Z'iz/�£- \ <br /> I Signature of ONneriContractor/Authonzed Agent �e ��J � <br /> I I <br /> . -"— -_ - .�_ ,..�,_ ._.-..w��.. .-:�uwcc.. �.aw-...:a,asR,�,w-n:�. 'rs„n� -. .�., <br />