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��RMIT APPLICATIUN <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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �7/0 � Mo�o7 -o�B <br /> LEGA LOT N0. BLO K TRACT <br /> DESC. <br /> OWNER ADORESS 01TM/ZIP 2 S-3 PH S�Z �S4"S4 � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � I--� o F' y�µ � ��� � Ct-+ �� niT:- <��, 3Qii- 79'aS <br /> CONTRACTOR (>cspe.,-s�� �•,.� � Tw �ss CITY2IP PHON�S-oj,d/)_�y �- <br /> CONTR.LICENSE f! 7C �� �'i-S'�O ,V�✓ nl/PHo«g �T ( �G�3 j/-j9oS"' <br /> �es P` e ��lS-c:� ,/Lcsl3a� eilZ j'7�>.� fe// <br /> /7' <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Olher � <br /> — — — �OCsD'"D �- <br /> WORK DESCRIPTI N / � <br /> � :.- �S'N�r�7 e_ :7C�e�» f��a� %'/�� Z � / ��� � <br /> �f'���7-/! i" <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C-air handling unils <br /> Balhlub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas firepiace <br /> Dislnvasher Gas range <br /> Clolhes waslier Clothes dryer <br /> Waler healer Range hood <br /> Sink(servicelbadmoplelc.) Ezhaust(an <br /> Backtlow prevenler Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain �oiler <br /> Floor drain Refrigeration <br /> Grease irap Woodstove <br /> Roo(drains Olhe� <br /> _ Other _ r��� �'/E'�_ " <br /> CITY OF EVER[TT LOCAL SALES TAX CODE IS 3105 <br /> I hereby centify thal I have read and examined this application and know the same lo be true and correcL All provisions of laws and <br /> ordinnces governing Ihis type of work will be complied with whether specified herein or nol Tho granling of a permit does nol presume �, <br /> to give aulhority lo violale or cancel the provision of any olher stale or local law regulaling wnslruction ur the performance o( <br /> conslruction.Thal 1 am authonzed by fhe owner of this property to pertorm lhe work for which application is made anA I coinply with the <br /> Stale Contractors Law 18.27 RCW and 296.200 WAC. <br /> � <br /> ' .--=�-� � -- �--.�-�� <br /> Sig uro of Owner(ContractodAuthorized A n ' Date <br /> ��Z <br />