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! :RMIT APPLICATI �N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettv✓a.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �—I 3—t�9 <br /> SI7 ( �R�S �n ( �0 C.v�� fE'�?��--7�d-�OU PERMID� �! 7 <br /> L[GA LOT NO. BLOCK TRACi OR SUBDIVISION# <br /> U[SC. <br /> OrWNER ADDRESS '� �,,/ zvTy�q � p p�E <br /> �1..� � � Sav...,� �C.c� 1 � �a ��1� � 5 LL. . � ` � -t `Caa5o8�7g5� _. <br /> � ��s- > <br /> TENANTNA E CONTACiFORPERMIi PHONE <br /> E-MNL <br /> -G`ON A T � . RESS 1 Y/ZlP PHONE <br /> CONiR.LICENSE# i <br /> �,� �J:__2�_i <br /> USE OF BUILOING HEAT SOURCE COIdTRACT PRICE OF WORK I <br /> '�'/'� — — — I�1 �JLY� <br /> �!L. Eleclric Gas Other <br /> WORK DESCRIPTION <br /> ,.��1.�.-c1-C)� I <br /> i � <br /> PLUMBING MECHANICAL <br /> IJO. TYPE OF FIXTURE pR ITEM NO. TYPE OF FIXTURE OR ITE�d <br /> _ Toilel A/C-air handling units <br /> __ Balhlub Forced air syslems <br /> _ Lavalory(wash basin) Gas piping <br /> __ Shower Water heater <br /> ,._ Kilchen sink 8 disposal Gas tireplace <br /> _ Dishwasher Gasrange <br /> _ Clolhes washer Clolhes dryer <br /> VVafer healer Range hood i <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow provenler Heat pump <br /> Urinal Unit heater <br /> Drinkinc� Founfiin Boiler <br /> _ Floor drain Reirigeration <br /> _ Grease trap Woodslove <br /> Roo(drains Olher <br /> Other — - <br /> CITY OF EVERETT�OCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity thal I have read and examined this application and know tho same to be Wo and correct. All provisions of laws and <br /> ordinaces governing this lype ot work�vill be complied with whelher specified herein or nol.The granting of a permil does nol presume <br /> to give authorily to violale or cancel Iho provision ot any olher stato or local law regulating construction or the pedormance of <br /> construction.That I am authorized by Ihe owner of this propeRy to peAorm the work for which applicalion is made and I comply with the <br /> Sta,h:-Gontractors Law 1 F127 RCW and 296.200 WAC. <br /> � � �/`� � <br /> � C___— �J <br /> Signature of Ow er/ConiractnrlA borized Agenl Dalo <br /> / -- <br /> � \ , ... - -� - - ------ -- - -- - - <br />