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F� :RMIT APPLICATI� N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 5 a I� --�D <br /> 425-257-8610- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /� � 00 S - (�'j <br /> SITE ADDRESS PARCEL TAX I.D.p PEFMIT M <br /> 3G� �r�� r - �3 <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> 51'a0(i�<i� �cnkc,,'' �LC ;��?17 ��Y�-�oIIGrAte L-►�e��fi9��� '��5 i2 zi� <br /> TENANT NAME CONTACT FOR PERMIT PHONE TJ I 3t� <br /> �t��e ��. Ar5 �1--1-�' I i��C�' I',/��l.v�`,1 E-MAIL 1�1� Gf���� <br /> �y,.rc�� S�mf��� w"�b�� 96� °R3�� I�� N� �'nF1t�►,1 ' ��1EZ7a +�z5 36� 3'�'c� <br /> CONTR.LICENSE p <br /> sAt'E�S� �i 33 K� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Gvlrl f},Q('C 1 L�I y\o� _Electric _Gas_Other 71 I �� <br /> WORKDESCRIPTION �jZ �, f"rr,� �wf All �Iu,.L��� x'I'L�'GS �M�/I (�� F� tv/�� <br /> I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet � AIC-air handiing units � <br /> Balhtub Forced air systems <br /> � Lavatory(�vash basin) Gas piping <br /> Shower � Water heater _ <br /> Kitchen sink 8 disposal _ Gas tireplace <br /> Dishwastier _ Gas range <br /> Clolhes washer _ Clothes dryer �Q � 0 � <br /> � Waler healer _ Range hood � <br /> I Sink (service/bar/mop/etc.) _ Exhaust fan <br /> 6ack0ow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> � Floor drain Reirigeration <br /> _ Grease Vap Woodstove <br /> Roo(drains � Olher Rlu�i ���t�(� <br /> _,L Other 4in� �: cL,��f7;�ti�urnj,7-���� _ �— <br /> .J— 'f�IRPQ_ r�.nf,.v.�r/n�+� S.nJ� _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby certify Ihat I have read and examined Ihis appiication and know the same to be hue and correct. All provisions of laws and <br /> ordinances governing Ihis lype of work will be complied wilh whether specified herein or not.The granting of a permil does not presume <br /> lo give aulhorily lo violate or cancel Ihe provision of any olher stale or local law regulating consWction or lhe performance of <br /> consiruclion. That I ain aulhorized by the owner of this properly lo perform lhe work for which appiication is made and I comply wilh the <br /> (�tate Coniraclors Law 18. 7 RCW and 296200 WAC. <br /> F��P,, [�t�n/�M�.� 5-I `►�Iu <br /> ign ure of wner/ContraclodAuthorized Agent Date <br />