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i <br /> �- PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVECES <br /> 3206 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettFva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � `�c� ��, <br /> SITE ADDRESS PARCEL TAX I.D.# RMIT a`� <br /> Z�43 Co�b:. ver �.�� oc: `��1�lf"loo^��o � ';�t! - n-„^ <br /> IEGA LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> !)ESC. <br /> UWNER ADDRESS CITY2IP PNONE <br /> `��c�a� 2ec�� Cstc•.re. Pa. r3oxsz�� C-ver-et� �l2�zc�� (y�z5)25L-5�c.�c,� <br /> TENANTNAME I CONTACTFORPEflM1T PHONE -���_–���y_(1��� <br /> V <br /> �C����p:, 1����G -H 1 U51C� �ereme w�ck;N�;rn e-new��crcmewr?���tFep���,,,n� 1 <br /> � �nC.ii in <br /> V.1r11 C �1urv�h�r�cj��Y�L �1321�l�C St S F, '�(� c <br /> 3�0 ��,�� - << <br /> CONTR.LICENSE 7! l!�- �� <br /> ���bLF t=PT c�5=�G3 M Lr,rae� l�:(� ��`i�Zl�. <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WOfiK <br /> �'rl'l�o�. �l ��_C•. -1 ��GS�G —Eleclric _Gas_Other 1-t10�2�•��i <br /> WOi�K DESCRIPTIQN <br /> C�rounCl WC�K, rc��cJh-�r� � Gr�cl ir�m c�< Y��� re�<Y�rrn <br /> Y11C�Y-2 -(�Y�Ca1 CpY�riCC�hC-i� "1U CcX �i A�1 Si'(:�ilUr� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTUHE OR ITEM <br /> _V Toile� A/C–airhandlinguniis <br /> Balhlub Forced air systems <br /> _ 1 Lavalory(wash basin) Gas piping <br /> Shower Waler heater <br /> _ Kitchen sink&disposal Gas lireplace <br /> _ Disliwasher _ Gas range <br /> Clolhes�vasher Clolhes dryer <br /> 1 Water heater Range hood <br /> � Sink(service/barlmop/elc.) Exhaust lan <br /> Backllow preventer Hea�pi�mp <br /> Urinal Unit hea�er <br /> Drinking Fountain 6oiler <br /> _ Floor drain Relrigeration <br /> Grease irap Woodstove <br /> Root drains Other <br /> � Other R P �3.t'. 3/ti' <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ccritily that I have read and examined Ihis applica�ion and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whelher specified herein or�ot.The granting ol a permit does not presume <br /> to give authority to violale or cancel Ihe provision of any other stale or local law regulating consiruction or the performance ot <br /> construction.Thal I am authorized by lhe owner ol this property to perform the work lor which application is made and I comply wilh the <br /> Stale Coniractors Law 18.27 RCW and 296200 WAC. <br /> `����-- �C ��'--� 3 � =� <br /> Sig at o wn /Conlraclor/Aut iorized Agent Da e <br />