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��RMIT APPLICATIL N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��I�J��� <br /> 517E ADDRESS PARCEL TAX I.D.Jt PERMIT N <br /> 31v25 y��4� Sv�� r= <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION M <br /> DESC. <br /> OWNER A�DRE:55 CITY/ZIP PHONE <br /> �J�! C��tr�2 v-� s1i� � �� edEiz�rt 9Ba�l <br /> TENAhT NAME CONTACT FUR PEPMIT PHONE �jl ,C(,�j -31� <br /> L�V:�C-�R�7`7 I ��wl�^� E-MAIL cZ�dYIU�✓/WI'aD•COM <br /> -�aH,�-a ��� � ����1uc� a�Ra• rN�wyc.-r� s�� ��-3a33 <br /> CO!ITR.LICENSE N �I(��S <br /> -�R�GS�F 4710Z <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> _Electric �Gas_Other !' ��� ��� <br /> WORK DESCRIPTION , I <br /> N�s'��[- C(1�3Tp��i�� "W,�l�l[�tD K�=�1� la7�'�D '��W� `�°�� �L1f�-� N� <br /> A�(lb wc.p#�7`��• .�2�t11.�/ kND I�J�i�1- (i-'Tt� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE 6F FIXTURE OR ITEM <br /> Toilet ,� A/C-air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ 3as piping <br /> Shower Water heater <br /> Kilchen sink&disposal Gas firepiace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/badmop/etcJ i Exhausl fan <br /> Oackflow preventer _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> floordrain I Refrigeration <br /> Gmase trap Woodslove <br /> Roe(drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify Ihal I have read and examined Ihis applicalion and know the same to be true and correct. AII provisions oi laws and <br /> ordinances goveming ihis rype o�work will be complied with whe�her specifed herein or not. The granting of a permit does not presume <br /> lo give authority to violate or canc I ihe provision ot any olher state or tocal law reguiating consWction or the performance oi <br /> constru ' iat I a i by ihe owner of this property to periorm the work tor which application is made and I comply with the <br /> State o a or 2 and 29�.200 W�C. <br /> � � 5asi� <br /> Signa ure of OwnedContractor/Aulhoiized Agcnl Date <br /> �!L <br />