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�ERMIT APPLICATIuN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> I 425-257-8810 - FAX 425-257-8357-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �2�z� g��>r�G�-�e�l �lwy a�os�oo��-��cc �v�� �;,� -o4� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION t! <br /> DESC. <br /> pyy����� ADDRESS CITY2IP PHONE <br /> r�v�;�f�-�-�t� <br /> ��`' — <br /> TENANT AME CONTACTFORPERMIT PHONE�S_S'c�j �g¢ <br /> ��-��i�-�s-s� sw�P ��`GG.r� <br /> E-MAIL <br /> CONTRACTOR ' ADDRESS CITYIZIP PFiONE <br /> �Gc.s�E"�-Nf�=t-tC,� ��- ��.¢ C(-i/Cc f�` cC.F� � ��s'_s-o5'_8Y8�{- <br /> CO�R.LI�oCEN��,M`�S�IJ'C7 �'G�L� S�Lef�S GOG.�O <br /> 'w�l-�-TLL J <br /> U,ySE OFBUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ` `��������� _Eleclric _ as_Olher ��"Zr ��G� <br /> WURK DESCRIPTION / � `l� �� `�,� �hLj�F <br /> ��� ����"� ��<1����(d����u� � �t�'ou��-!�` <br /> ma ���'?a � �r�..� f�f7� � �'l/C��2G,cc� <br /> PLUMBING MECHANICAL <br /> NO. TYPE O�FIXTURE OR ITEM NO. TYPE OF fIXTURE OR ITEM <br /> Toilel A/C-air hand�ing units ( � <br /> Bathiub Forced air systems <br /> Lavalory(wash basin) �J Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes oryer <br /> �Vater healer Range hood <br /> Sink(service/bar'mop/elc.) � Exhausl(an <br /> Back(low preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> _ Grease trap Woodsl�� ���� <br /> _ Roo(drains � OtherT_ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I iiereby ceritify lhat I have read and examined lhis application and know lhe same to be true and correcL All piovisions of laws and <br /> ordinaces governing lhis lype of work will be complied wilh whether speci(ied herein or not The granting of a permit does not presume <br /> to give aulhority to violate or cancel the provision o(any other state or local law regulalinq consiruction or the pertormance of <br /> construction.That I arn aulhorized by the owner o(this property to perform the work for which applicafion is made and I r,omply with lhe <br /> Stale Contractors la�,v 18.27 RCW and 29G.200 WAC. I <br /> �,�--��f�/�'L��y�� �D--/6��8` <br /> SignaWre o(, wnedConlractorfAuthorized Agent Date I <br /> __ '� � � <br /> � <br />