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��RMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED fROM 8 AM TO 4 PM S ` e�S 07 <br /> SITE ADDRESS PARCEI.TAX I.D.N RMIT N <br /> 2$ n� e Sc . �C�U�O� <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. � � CITY2IP PHONE <br /> OWNER ADDRESS <br /> N ��''^-I S � e� '-_'„ PHONE <br /> TENANT NAME CONTACT FOR PFRMIT <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> � G\��ti � <br /> CONTR.LICENSE M <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eloclrlc Gas_Othor <br /> WORK DESCRIPT�ON <br /> `` C � ���`J� <br /> PLUMBING MECHANICAL <br /> NO. � TYPE UF FI%TURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> Toitet _ AIC–alrhandlingunits <br /> Balhtub _ Forced alr syatems <br /> Lavatory(wash basin) _ Gas piping <br /> Showor _ Water hoetor <br /> Kitchon s�nk 8 disposal _ Gas flreplace <br /> Dishwasher _ Gasrango <br /> Clolhes washer _ Clolhes dr�er <br /> Walar heater ,_ Range hood <br /> Sink(sorvico/bar/moplatc.) _ Exhauslfan <br /> Backflow provontar _ Heal pump <br /> Urinal _ Unil heator <br /> Drinking Founlain _ Boller <br /> Floordrain _ Retrigeralion <br /> Grease lrap _ Woodstove <br /> Roof dreins _ Olher_ <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I horoby corilify lhat I have read and axamined lhis applicalion end know the same to be Irue a�d cortect. All�rovislons at lews and <br /> ordinaces governing lhis lypo of work will be complied wilh whelher epecified horeln or nol.The granting o(a F�artnit does not presume <br /> to givo aulhoriry to violale or cancel the pmvislon at sny other slale or local law regulaUnp conslructlon or the pedormance of <br /> conslruclion.That I am authorizod by lhe owner of tl�is propeAy lo peAorm lhe work for whlch applicatlon Is mado end I comply wlth the <br /> Stala Conlrecrors Law 18.27 RCW�296200 WAC. <br /> --� � . -� �� �� s'�.z.�_ ,�T <br /> Signatureo OwnrxlContrectorAuthodzed genl Dale <br />