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��RMIT APPLICATlti,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 ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.p PER IT N <br /> �{/Id (�.l•tff DR oo9�91meaoG9o0 �/G/ -q� <br /> LEGA LOT NO. BLOCK T�RApCT OR SUBDIVISION M �/p <br /> DESC. G �DD'D 'DO It��71WK Y/E�Gd /�GL)'//Av rD EUu71CIT <br /> OWNER ADDRE53 CITyIZIP E . <br /> RU`�idu ticv�Sa�Y �llro cuFr �,p ,�vCR�/, qdze� Z°�- 7i8-sre9 �> <br /> TENANT NAME CONTACT FOR PERMIT „t � <br /> � JY�/r� I ZFG�7����— E-MAIL <br /> g]ZEG2 o�+1E S.ER✓ft.�5 �� EOMONDS -/�5-'7T 3—Z 2'�Z <br /> CONTH.LICENSE It <br /> sr�'c1�y�37Dc� �/IP �� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> s//�l�T(.���}/y/(A' R�S(��C� I _Electric _Gas_Other /S�db <br /> WORK DESCRIPTION <br /> �tBCI�GI� �X�lSr G?�-dK �;� 7 �s�' <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet __ A/C–air handling units <br /> Bathlub _ hurccd ak systoms <br /> Lavatory(wash basin) _ Gas piping <br /> Shcwer _ Waler heater � <br /> Kitchen sink 8�iisposal _ Ges fireplace � <br /> Dishwasher _ Ges range ��/`}�1g/� <br /> Clol'iea washer _ Clothes dryer 11� <br /> Water heater _ Range hood l / <br /> Sink(servicelb.idmop/etc.) _ Exhausl fan Vv�� � L4e t <br /> Backllow preve�ter _ Heal pump , � Y <br /> Urinal ._ Unil heeler � �'� ��� <br /> Drinking Fountain Doiler y 't <br /> Roor drein _ Refrigeration �V � 1 <br /> _ Grease trap _ �Woodstove y �ti6' <br /> _ Roof drains — �,� <br /> Other <br /> CITY OF EVERETT IOCAL SAI.EB TAX CODE 19�706 <br /> I hereby certify thal I h,ave read end examined this applicAtion and know the seme lo be true and correct. All provisions ollaws and <br /> ordinances governing this type of work will be complied with whether specified herein or not. The granling or a permit doea not presume <br /> to give authorily to vidjle or cancel the provision ol any other sta�e or local law regulating construclion ar the peAormance af <br /> construction. Tliat I em authorized by Ihe owner of this propeAy fo perform Ihe work for which epplication is made and I comply wi�h ihe <br /> Statg ontractors LawA82�RC and 296200 WAC. <br /> � � � l� ,S'�d <br /> S n ure of OwnedC traclor Aulhorized Agent Date / <br /> IZ <br />