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� :RMIT APPLIC�ITI�,N <br /> CITY OF EVERETT PERMIT SERVICES Cy ''S� <br /> 3200 CEDAR STREET, EVERETT, WA 9$201 ��O ,�Y}� <br /> 425-257-8810 —FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM (���.`7�IO �! <br /> SITE ADDRESS PARCEL TAX I.D.q PERMIT# n� <br /> � d "�J <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION M r I ' / /'7(� <br /> DESC. \7 ZS� 7�O" l(Q' <br /> O' J � � ' " '�� ���y� /l� l ADDRE$SU l �..--.�/V�L�CI �`i�� �v/NE��� <br /> y � 3 <br /> TENANT NAME I CONTACT FOR PERMIT ��1/Uf� PHONE <br /> ! <br /> r� E-MAIL <br /> s� �g <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORI< <br /> _Electric _Gas_Other <br /> WORK DESCRIaTION � <br /> ; � u� �� � � �LL' <br /> o��� ��- � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEhI NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C—air handting units <br /> Balhtub Fcrced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplaco <br /> Dishwasher Gas range <br /> Clothes washer Clo�hos dryer <br /> Water heater Range hood <br /> Sink (serviceNar/mop/etc.) _ [xhaust fan <br /> �ackliow preventer _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeralion <br /> Grease trap _ Woodstuve <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7p%CODE 13 7105 <br /> I hereby certify Ihat I have read and examined this applicalion a�id know ihe same to be truo and correct. All provisions ot laws and <br /> ordinances governing lhis type of work will be comptied with whether specifed herein ur nol. The granling of a permit does not presume <br /> to give authority to violale or cancel Ihe provision of any olher state or local law regulating construction or the pertormanr,e of <br /> consiruction. Thal I am authorized by the owner of this property t�eAo{m lhe�k for which applicalion is mada and I comply with the <br /> State Conlractors Law 18.27 RCW and 296.200 WAC. � `�' <br /> 1L�,� � � / �o <br /> Signa� e of OwnedContractor%Aulhonzed Agent Date <br />