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� Er2MIT APPLICATiJ�i� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 5200 CEDAR STRE�T, EVERETT', WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DE81T&CREDIT CARDS ARE NOT ACCEPTED <br /> SI7E ADDRESS PARCEL TAX I.D,tt PEF}�j11J�,/ � <br /> 2 a ��I6 a�– oa 3 � � oo �7�a .����' <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. `� <br /> OWNER ADORE55 CITY2IP PH <br /> .7�t h Sr.t p `j i /��g /haL/�.ev �,'lc/ T/f�oHq z�6i�—z�uL I <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �Gr h �' Sti� �' �' �.-06 — 3'�S�= 9�o� <br /> CONTRACT C�.�y (�(�/C�y ADDRE55 CITY2IP PHONE <br /> CONTR.LICENSER� TCO O .. �bd�j h7 .�1' r���b ���� ���3r��—lOd,.S <br /> EE,�C� �f <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRIGE OF WORK <br /> `�Electdc _Gas_Other � ljl,f'6�— <br /> . i <br /> WORK DESCRIPTION <br /> 7c/Z i Y���' a���'tirG.�,� <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> `� Toilet A/C—air handling units <br /> 8athtub Forced air systams <br /> Lavatory(waeh tasin) —7 Gas piping <br /> Shower Watar heater I <br /> � itchen sink&disposal Gas fireplace <br /> ✓ ' hwasher .. as ranga <br /> Clo es washer thes dryer I <br /> i Laun tray ✓ Ra e hoad <br /> Sink(s icelbar/mop/etc.) � Exha t fan <br /> Backflow eventer . Heatpu p <br /> Urinal Unft heat <br /> Drinking Foun in ✓ Boiler <br /> �— Floor drain Refrigeralion <br /> � Grease trap Woodstovn <br /> Roof dreins Other <br /> _ Other _ <br /> CI?Y OF EVERETT LOCAL SALES 7AX CODE I5 3105 <br /> � hereby ceritify that I have read and examined this appllcation and know the same to ba tiue Y�d correct. AII prov(sions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein er nut.'r,;a iranling of a permi;does not presume <br /> to give authonry to violate or cancel the provision of any other state or local law regulatlnp ccns�vci'on or the performance of <br /> constructlon. That I am authorized by lhe owner of this property to perform the work fer�vhir.h i,�pl�:etion is made and I comply with the <br /> Stat ontractors Law 18.27 RCW and 296.200 WAC. <br /> �� � ��, � `. 6 Jl'_ <br /> Si ture of Owner/ContrectorlAuthonzed Agent Date � <br /> 2 <br />