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� cRMIT APPLICAT�vN <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 ��- -j _O� <br /> SITE ADDRESS �� �� � � G� PARCEL TN(I.D.N PERMIT N <br /> • �n� lu � Cl�'S����� �-D f� v�-vU� <br /> LEGAL LOT NO. BLOCK TRACT OR SIIBDIVISION N <br /> D[SC. <br /> OWNER ADDRESS CITYRIP PHONE <br /> �oEi�1h <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> ('Sn E i N� (�r✓A n-� y7,�'-EX7� .zs9 � <br /> _� <br /> �r•� w �, <br /> CONTR.LICENSE M <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> r�� I�C� I _Electdc _Gas_Olhor I n(�I n �j� <br /> WORK OESCRIPTION <br /> /��Sr�a� �}n� UFGr�.�- ►�E <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> Toilol AIC—alr handling units <br /> Bathtub Forced air syslams <br /> Lavalory(wash basln) _ Gas pfping <br /> Shownr Water healer <br /> Kitchen sink 8 disposal Gas flreplace <br /> Dishwashar Gas range <br /> Clolhes washor Clothea dryer <br /> Walor heater Range hood <br /> Sink(sorvice/bar/mop/etc.) _ Exbausl lan <br /> Backllow preventer _ Heal pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodslovo <br /> Roo(drains _ Other <br /> Other _ <br /> CITY OF EVERETf LOCAL SALES TA%CODE IS J105 <br /> I horoby cerilify ihat I havo read and ezaminod lhis application and know lhe same lo be Irue and corract. All provisions of laws and <br /> ordinaces governing Ihis lypa ot work will be compliad with whelhor spocified hereln or�ot.The granling of a permit daes nol presume <br /> to givn authority lo violate or cancel iho provislon of any other state or local law regulaling wnslructlon or lhe performance of <br /> construclion.That I am authorized by the owner ol Ihis property to perlorm lho work(or which application Is made and I comply vnih lhe <br /> Stat Contractors Law 18.7�7 RCW and 296.2�WAC. <br /> i>-9-.,.�r.,� � .��v�1,���-�/� ' L �• �� <br /> i naturo o(OwnedContractor/Authorized Agent Date �,z <br />