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�RMIT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM (.� „ a I _Q � <br /> SITE�DRES��U���� P RC[l TAX I.D.� PERMI <br /> 30�� t- r z, v !�L O D ��� �� <br /> LEGAL LOT NO. BLOCK TRACT dR SUBDIVIStON M <br /> DESC. <br /> O�V HER ADDRESS CIT'21P PHONE <br /> �loy �/��FIRti1PASSErLy 3��� SR,O/iDI�A� L=V�£� 9820 � �yz5)7_52 -53&'8 <br /> TENANT NAME ( �I y� CONTACT FOR PERMIT PHONE <br /> � �� <br /> ��,N�a� ' ` ` � �oy �� ���M���F�/ e-�� JoY�z�,����r.t <br /> � <br /> CONTR.LICENSE M �-`�G�� <br /> �USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> / ��, `� �,� „ ,-� r Eleclnc v Gas_Other <br /> �IVORK DESCRI!�TION / <br /> (�= ���" �' ' - ' <br /> PLUMBING MECHANICAL <br /> NJ. TYPE OF FIXTURE OR ITEM NO. YYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathlu� Forced air systems <br /> Lavatory(wash basin) y� Gas piping <br /> Shower Water heater <br /> � Kitchen sink&disposal _ Gas fireplace <br /> Disliwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mopletc.) _ Exhausl fan <br /> Backllow preventer _ Heat pump <br /> Urinal Unil healer <br /> Drinking Founlain _ Boiler <br /> Floer drain Refrigeration <br /> Grease lrap _ Woodstove <br /> _ Roof drains _ Olher CCi-I�L�c�. ��ti`�'��'-� ��'�� <br /> _ Qlher Pvn��acL [�ht:t�1, _ I <br /> �im k•_/rio.� i�.lt. — . <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I liereby ceritify thal I have read and examined this application and know Ihe same to be Irue and correcl. All provisions of laws and <br /> ordinaces governing lhis typc of work will be complied with whr,ther specified herein or noL The granting of a permit does not presume <br /> to give aulhonty lo violale or �ancel the provision of any olher state or local law regulating construclion or the performance of <br /> const c�' ,7 at I am authcrized 6y lhe owner of Ihis property to perform the work for which application is made and I comply with the <br /> Stal p �r c�s Lav+ 18.27 RCW�nd 296.200 WAC. <br /> :�� � ,,,� :.;, � �/3 °� - <br /> Signa ure of OvmedContr clor/Aull " d Agenl Date <br /> ��L <br /> _ � <br />