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F .RMIT APPLICATI( ,V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.K PERMIT N <br /> ���c ('o� AtlE -0�8 <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION 1 <br /> DESC. <br /> OWNER ADDRE55 CITY/21P PHONE <br /> CEI� <br /> 51�,�e�N� E�s�� ���o /'o�,e�' A✓�- ��f�- 9�zo� ��zs)z3i��z� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> NEC11�hE P F/�clE� 3�3! /,�6 F�., S.E, fUE£Eff ?C+�B C12S) Sb8-�7E3b' <br /> CON'fR.LICENSE M <br /> l-�ECiTra77ry1h. <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 1�rSi�E,���C _�ledric _Gas_Other I �g,�3 J, SD <br /> WOFtK DESCRIPTION <br /> �'r,EUtrt� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM ND. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling units <br /> Oalhtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas renge <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(serviceNadmop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Pountain Boiler <br /> �loor drain Reirigeration <br /> Grease lrap Woodstove <br /> Roof drains Olher <br /> Other <br /> — / — — <br /> � � CITY OF EVERETT LOCAI SALES TA%CODE IS 31 OS <br /> I hereby certify lhat 1 have read and examined this application and know the same to be true and conect. AII provisions o(laws and <br /> ordinances goveming this type of Work,�vill be complied with whelher specified herein or not. The granting of a permit does not presume <br /> to give aulhonty to vidale or canCel ti�provision n1 any other state or local law regulating construction or the performance oi <br /> construction. That l am aulhorized byy the owner of this properly to perform the work tor which application is made and I comply with the <br /> Slate Contradorg'Law 18.2712CW{and 29�200 WAC. <br /> J�. ' 1���t�D", �,�i/°i�_ o�-/?-ro <br /> Signalur�oT�OwaerlCoq ract�Ihorized Agenl Dale <br />