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i��RMIT APPLICATit,�� <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 FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # <br />/�9'7 -7�'�" � SE DO�{ lOZoOoo 7So� <br />LOT NO. � BLOCK TRACT OR SUBDIVISION # <br />7S- Oa� - n.cc C( a �'c N,..,.,,, a-- Nf� e <br />��v.tc� � k�- Ti��� I �37 - SD�` ST. S�. <br />TENANT NAME CONTACT FOR PERMIT PHONE G'z.�� 8�.b C�L�r Z, <br />I ��jV � VLIY� `JI�jU.� E�h7PJL-�G`�,SI�[�G�J.�.. U'�� tA <br />�,N S�.y cf< �{f, s <br />CONTR. LICENSE # � I A� 1 SL � <br />v �•irv <br />USE OF BUILDING <br />G <br />WORK DESCRIPTION <br />� <br />t" � gox t3 <br />/N( _ <br />HEAT SOyR�� <br />��� <br />Electric Gas Olher <br />(OlOtlr 1..�Y.L✓�"�'vnc. �g � b <br />' �70 — C'1�j/Z <br />�ONTRACT PRICE OF WORK <br />/SjDoJ <br />G�✓'a� '�'dr+,��� �-o eX� s�,.� �,�►���.�� �jc..,�r,,,� <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />W ater healer <br />Sink (service/bar/mop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasa trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />W ater heater <br />Gas fireplace <br />Gaa range <br />Clothes dryer <br />Range hcod <br />Exhausth3n <br />Heat pump <br />Unit hed�er <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y thal I have read and examined this application and know lhe same to be true and correcl. All provisions of laws and <br />ordinaces governing this type of work will be complied vrilh whelher specified herein or nol. The granling of a permit does not presume <br />to give aufhority lo vielate or cancel the provision of any olher stale or local law regulating construction or lhe pedormance of <br />construction. Tt I am aulhor ed I he owner of this properly to per(orm Ihe work for which application is made and I comply wilh the <br />Slale �ontrac s Law 1f1.2, RC :�nd 29G200 WAC. <br />Signal re o( O�erl ,o�ctor/Au rized Agen� Dale ` O� 1 <br />%y <br />H�' <br />