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FcRMIT APPLICATIvN <br /> CITY OF EVERETT PERMIT SERVICES 2 � <br /> 3200 CEDAR STR�ET, EVERETf, 1NA 98201 � <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org �/�,��I <br /> � � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS c!��B PARCEL TAX I.D.# P MIT#1 <br /> ZCo ?o lo�=` s-�-R�EI' �9051�7-• ooz - l�l-oo I ,j(J �? <br /> LEGAL LOT N0. BLOCK S#riEF <br /> DESC. SEc. I-I�Towasrfir29 /JoRTea� T�qM6E $ �AST� �•h1• <br /> OWNER ADDRESS CITYIZIP PHONE <br /> Gh�R�S'1�NSE'N rpiu[aury F+oi..�ES� rn�c, Zo3a Ruc�c�R AVEg�F EVER�T �S 303 8G55 <br /> 992o I <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> �06 GNRlS'iE�15ErJ `'F25 Z�9 I&Z2 <br /> CONTRACTOR ADDRESS CI1Y21P PHONE <br /> GH-RIST�N5E�1 G.2uRWTY }}ONEy� �NC E'VE'RETT <br /> CONTR.LICENSE# 203o RKcKtR/avEttH� 48Zv1 '�'zs Z�9 �g`''Z' <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> I�ENTR L ✓Electric Gas Other l 7S� "�o. '�2Gt3//O <br /> WORK DESCRIPTION <br /> �3u��� A TJ�-t V�.EX <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR I7EM NO. TYPE OF FIXTURE OR ITEM <br /> _� Toilet A/(,-air handling units <br /> Z Bathtub t3_ Forcedairsystems i,..ts,�� HEitTERS <br /> _(� Lavatory(wash basin) ,9� Gas piping <br /> _� Shower �_ Water heater <br /> � Kitchen sink 8 disposal �_ Gas fireplace <br /> �_ Dishwasher Gas range <br /> 2 Clothes washer < Clothes dryer <br /> _ Laundry tray � Range hood <br /> _ Sink(servicelbadmop/etcJ _� Exhaust fan <br /> Backilow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> � Floor drain _ Refrigeration <br /> � _ Grease irap _ Woodstove <br /> I = Roof drains _ Other <br /> Other <br /> � — <br /> � CITY OF EVERETT LOCAL SALES 7AX COOE IS 3105 <br /> ! I hereby ceritify lhat I have read and examined this appiication and know the same to be true and correct. All provisions of laws and <br /> iordinaces goveming this type of work wil! be cornplied with whether specified herein or not The grarting of a permit does not presume <br /> � to give auchority to violate or cancel the provision of any oUier stale or local law regulating construction or the performance of <br /> i construction. That I am authorized by the owner of this prnperty to perform the work for which applicati�n is made and I comply with the <br /> � State Contrectors Law 1 27 RCW and 296.200 WAC. <br /> ��-,�C��- / <br /> � Signature of OwneriContractor/Authorized Agent Date � <br /> y/JJ(it�i 7Zy'S <br />