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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 4^.5-257-8857 - www.everetiwa.org <br />� c� ��� APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />�z��h p� �'P�' G3crt��Pll�+c'11 <br />L[GAL 10TN0. BLOCK � <br />DESC. <br />PARCEL TA% I.D. M <br />OR <br />PERYIT N <br />� <br />`�� `� L�(„ - � • . <br />1��'.C�1Y1��S 1���� 2028' ��-���' PL SF t��re�Yi �"z�-33�-L913 <br />TENANTNAME CONTACTFOAPERMR PHONE f�Z�_�y�'S-3�J��Z..� <br />��t 1'r'v� � (��u,�'1Gi S I �i � I� � VYeVo <br />�' E•MAIL �I �C ��J`�J�+1 �S . Y11�.�. <br />L9TV7! <br />S�c��� ��►�f, �ZnC. �,u RcX 2�I�o� Rt�clmm'�G� 425-$$ti-32ot� <br />CONTR. LICENSE / <br />��i GrNPF'1�' c�I lN7 <br />USE OF BUILDING <br />WORN DESCRIPTION <br />�t bY� Ca'"� 1M <br />� HEAT SUURCE CONiRACT PRICE OF WORK <br />6ectnc Gas O�hcr � L1� ( O� <br />C�hr� Li� S�� Gi � �Gt.1 1,�'1 �"I ��l 0✓� U,111D1''�� ,�l G'�•� <br />N0. I TYPE OF FIXTI;RE OR ITEM <br />1oiIC� <br />�athlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen ,ink 8 disposal <br />Dishwashe� <br />Clothes w;�sher <br />Water heater <br />Sink (service/6avmop'etc.) <br />Dackflow preveNer <br />Urinal <br />Drinking Founlain <br />Floe� drain <br />Grea: rap <br />Rool oiains <br />Olher <br />NO. I TVPE OF FIXTURE OR ITEM <br />A'C — air hanAling units <br />Forc�d ai� syslems <br />G�s piping <br />W �ter healer <br />Ga:, lireplacc <br />Gasrangc <br />Golhes dryer <br />Range hoo�1 <br />E�haust fan <br />Heat pump <br />Unit hcaler <br />Doilm <br />Rclrigeration <br />Woodstove <br />Othcr__ _ <br />CITV OF EVFRETT LOCAL SALES TA% CODE IS 8505 <br />I hereby cerilily Ihal I have o,+� md examined Ihis applu;ation and know Ihc same to be liue �nd correct. All provisions of laws and I <br />oidinaces goveminp this !/pe c� wcrk will be complied with whether specilied hcreir or nol.'. he granling ol a permil �oes not presumo <br />to give authority lo violate or cancel tiie provision ol any olher stale or lowl Ww regulating construction or tho pnrlormane:e ol <br />consirur,tiqn�That I am authorized by Ihe owner ol Qiis propohy to pedorm Iha work lor which applica!ion is made and I comply wilh Ihe <br />Stale Goniiariurs Law 18.27 RCV� and 29G200 WAC. <br />� /�I /�� <br />_'�'=J� <br />