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,_. <br /> ��RMIT APPLICATI�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 ACCEPTEO FROM !AM TO 4 PM //.�/6 —O� <br /> � <br /> SITE ADDRESS � PARCEL TAX I.D.N PERMIT N <br /> -��o w, c >,Nb � � - � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY21 P ONE <br /> ���r N� <br /> TENANT NAME CONTACT FOR PERMIT PMONE (/r� I�`�/L�i y <br /> (3�Ei�✓G LE'or/A-� r�/k��-s�� E�N� � <br /> EIlJ� <br /> CON?R.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> IN o✓�k Sµ�P/�►'�F"'GE I _Electric _Gas_Othor 2S`U <br /> WORK DESCRIPTION <br /> ��r_.o �n-r-s 3 ('h w� VLA�-e k_ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilol A/C—air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kilchen sink&disposal Gas(ireplace <br /> Dishwasher Gas range <br /> C�othes washor Clolhes dryer <br /> Water healer Range hood <br /> Sink(sorvico/barlmop/otc.) _ Etthaust fan <br /> Backflow preventer __ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boller <br /> Floor draln Reirigeralion <br /> �roase trap _ Woodslove <br /> Roof dreins Other <br /> Olher <br /> C�?Y OF EVERETT LOCAL SALES TN(CODE 18�105 <br /> I hereby ceritify that I have road and examined thls applicalion and know the same to be true and correcl. All provisions o(laws and <br /> ordinaces governing Ihis lypa of work will be complied wilh whelher specilled herel�or not.The grantinp of a permit does not preaume <br /> to give authorily to violale or cancel lhe provision o/any other state or local law regulaQng conslructlon or Ihe peAortnance of <br /> construcl�a�rized b lhe owner o(Ihis p�'�rty t��r(orm ihe work for which epplication is made and I comply wilh lhe <br /> Slal Conlractors Law 7 RCW nd 296.200 WAC. <br /> Signaturo of Owner/Conlractor/Authorized Agent Date � <br /> N <br />