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� �RMIT APPLICATII�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM t,�� 3 _D�o <br /> SITE ADDRESS PARCEL TAX I.D.A PERMIT t <br /> 3yi �.4ur-oa�.� Mo�o3 •0 � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE88 C 21P PMONE <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> Jot�vsra,.�. �4ron�v KEN �lAt� ('-�ZSI 25Z- 31I'7 <br /> CONTRACTOR ADDRE CITV2IP PHONE <br /> CuF�c',� Stfl--[� H�vrr? A�fc 2�zo ��� Eve,a�,t- 4kza (ws� uz- a�i�- <br /> CONTR.LICEN8E N <br /> � 1�c'SSSo�.Zor <br /> USE OF BUILDINO HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> �� ��Qu�� _ElecMc �Gas_Other <br /> WORKDESCRIPTION ���5� 'E ����� 3 �V�i .r�y��s <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTUHE OR ITEM NO. TYPE OF FIXNRE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced alr syslems <br /> Lavatory(wash basln) _ Gae plping <br /> Sho Ner Water heater <br /> Kitchen sink 8 disposal Gas Iireplace <br /> Dishwasher Gas renge <br /> Clolhes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> Sink(servicelbar/mop/etc,) � Exhaust(an <br /> ! Backllow prevenler _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor draln Ref�igeralion <br /> Greasetrap _ Woodelove <br /> _ Roo(drains � Olher <br /> _ Olher �� <br /> CITV OF EVERETT LOCAL BALES TAX CODE 19 7106 <br /> I hereby carilify lhal I have read and ezamined thla eppl�cation and know Ihe e+ame to be Irue end correcl. All provlsiona of lawe end <br /> ordinacos governing thfs type of work will be complied wilh whether specilied hereln or not.The granting of e pertnil does not presume <br /> to glve authority to vlolate or cancel lhe provislon of eny other atate or local law regulatlnp constructlon or lhe pertormance ol <br /> conslructlon.That I am authorized by the owner ot lhia property to perfortn Ihe vrork for which eppllceGon Is made and I comply with the <br /> State Contraclora Law 18.27 RCW end 298.200 WAC. <br /> Slgnatureo ner/ onlractod ut odzed genf ete �JA, <br /> / l! <br /> �— <br />