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�tRMIT 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 ACCEPTED FROM 0 AM TO 4 PM <br /> SIT�(�DR� ^�S d 2./ PARCEL TAX I.D./ PERMIT A <br /> l. � � Q�� -�r� <br /> LEGA LOT NO. BLOCK TRACT OR BUBDIVISION M <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ���/� � <br /> TENAN'f NAME CO TACT FOR PERMIT PMP���,���ZS�9 <br /> ���1�� —�a�ea ���� ��5� y� <br /> E.Mu� <br /> ��2Y �c,�� Sysr - <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> (�r����/�/C�/�1 K/f-�OM _Electric _Gae_Olher 9�p�'O <br /> WORK DESCRIPTION <br /> �n�5.� J�/1� �C�� i <br /> PLUMBING MECHANICAL �i <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> Toitet AIC—air handling units <br /> Bathtub Forced aIr systems <br /> _ Levatory(wash basin) _ Gas plping <br /> Shower Waler heater <br /> Kitchen slnk 8 disposal _ Gas fireplece <br /> Dishwasher Gae range <br /> Clathes washor _ Clolhes dryer <br /> Water heater Range hood <br /> Sink(servlce/bar/mop/etc.) _ Exhauelfan <br /> Backltow preventer _ Heat pump <br /> Urinal Unft healer <br /> Drinking Founlaln _ Boiler <br /> Floor drain ReMgeratlon <br /> Grease lrap _ Woodslove <br /> Roof drains Other_ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> I hereby cerilify that I have read and ezamined lhis application and know the same lo be true end correct. All provlslona of laws and <br /> orAinaces governing Ihls type ol work will be complied wilh whelher apecifled hereln or not.The granling o1 a pertnil does not presume <br /> to give aulhority to violat�,or cancel the provision of any othar atale or local law regulaUng construcUon or the peAortne�ce ot <br /> construclion.That I am authorized by lhe owner of this property to perfortn the work for which applica6on Is mede end I comply with lhe <br /> Stale�l�lors La�18y7,7�CW a 296200 WA�. / <br /> �vi(A/ � / �3�6 <br /> Signal—ure OwnerlContractorlAuthonzed Agenl Dale l� <br /> 3 <br />