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F 'RMIT APPLIrATI 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 /> { 11 -b3��� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS " i1.1�1 l.l, I C��� ( � PARCEL TAX I.D./ PERMIT tl <br /> � i c, �'c1� � �;��.� 1 oblll DC�2i�L> �� ri -�7y, <br /> LEG LOT NO. BLOCK TRACT <br /> DESC. <br /> WNER ADDRESS CITY2IP PHONE <br /> r��'L111�,'� _~ ��11.: � ( bl �l�) �(��L��� � ��,'�'1��' t1i �l.f� � �����1� <br /> TENANT NAME CONTACT FOR PERMIT PHONE ' )1�1 f �. I��•�• <br /> / �l LL <br /> ��1(�in�� �IG ��cv:��r�l�-lZ it` ��1 �_ ��Ci�i��� i `� i'[�S1 <br /> CONTRACTOR����� �'l��t 11 f_ -{� ADDRE69 I�_:I ,' t-� ��` CITY2IP�� ��� �PHONE ���1� (� Y� - <br /> li ! <br /> / ( 1 <br /> CONTR.LICENSEN ���• � ���C� l�� .� ����)� - �����1.� ���_,� <br /> USE OF BUILDING HEAT SOURCt �a#–t- CONTRACT PRICE OF WORK <br /> — � •� <br /> �''��11 �1��i I ' I � �l � �[�ectric _cae_o�ner ��J , ���`,�`)— <br /> WORK DESCRIPTION � � � <br /> ����C��1 � �.,��.�� . ���� �C�vS�� �����oC , �z ������: �XI��� e>r <br /> ��(������' �� ��C � � 1�;C��r �. �v�5'� i��C� Ct�C�C���C�(k. <br /> � PLUMBING MECHANICAL <br /> Np, TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet NC–air handling unils <br /> Bathlub Forced alr systems <br /> Lavatory(wash basin) _ Gas plping <br /> Shower Waler heater <br /> Kitchen sink&disposal _ Ges fireplace <br /> Dishwasher _ Gasrange <br /> Clothas washer _ Clolhes dryor �r <br /> Laundry lry _ Range hood � `� <br /> Slnk(sorvice/badmop/ela) � Ezheustfan ,�,,-� <br /> BackBow preventer _ Heat pump `, <br /> Urinal Unil heater <br /> _ Ddnking Fountain _ Boller <br /> Floor drain __ Relrlgerallon <br /> Grease trap Woodstove <br /> Rool drains � Ot er Y� ���1, ��( (� <br /> Other � �J��'�` <br /> —� -- — — <br /> CITY OF EVERETT LOCAL SALEd TAI(CODE IS�105 <br /> I hereby cerilify that I have road and ozaminnd this epplicnlion and know lhe seme to be true end correcl. All provieione ot lews and <br /> ordinaces govorning this type ol work will be complied with whether specified herein or nol.The granling of a pertnit doea not presume <br /> to give aulhority to violalo or cancol Ihe provision ol any olher state or local law regulating construcllon or the peAormanco of <br /> , •truction. Tha! I am aulhonzed by the ownor ol lhla property lo perform the work lor which applicadon is made end I comply wilh the <br /> �Conlra�lors La�418.27 RL�V end 29G200 WAC. - <br /> ,�i I �L � � ��_ ��L {i _ �. `� � i � " � i j I <br /> Signat�(5wnorl ontraclod uthq ze gent a� � <br />