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F :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.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AA1 TO 4 PM <br /> SITE AODRESS PARCEL TAX I.D.N PERMIT N <br /> (o L Ui.f U O C.b 70G - / <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION R <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �1 A C o � R 4v�l� L � Go IL�I 4(D 2 Z Ca(.(3 Y /1L1(:' �VeQc:m <br /> TEN,ONT NAME I CONTACT FOR PERMIi PHONE <br /> LLL'.NV CIC- C.p��lrl�xTD2S E-MAIL <br /> CONTR.LICENSEN '� ��BCXZS��1 �C=R\�-hN� VJ/1 �'3)UO�"-7BJ$ <br /> ► ZLCNCZ �ol MA <br /> USE OF BUILDING NEAT SOURCE CONTRACT PRICE OF WORK <br /> �Electric _Gas_Other I / OCb UO <br /> WORK DESCRIPTION <br /> CtiAS H�,el C.z-nrc £x�eN rzcrv ( 14L�cn�� G�,ss i'-�.��c� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> _ Toilet AlC–air handling units <br /> _ Dathtub Forced air systems <br /> _ Lavatory(wash basin) Gas i in <br /> PP 9 <br /> _ Shower Water heater <br /> _ Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gasrange <br /> _ Clolhes washer � Clothes dryer <br /> _ Water heater Range hood <br /> _ Sink(service/bar/mop/etc.) Exhaust fan <br /> _ BackOow preventer Heal pump <br /> _ Urinal Unit healer <br /> _ Drinking Founlain Boiler <br /> _ Floor drain Retrigeralion <br /> _ Grease trap Woodstove <br /> _ Roof drains I O�her Ci��s /nc r'f.0 <br /> Other — — <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby certify thaf I have read and examined this appli;ation and know the same lo be true and correcl. All provisions of laws and <br /> ordinances governing this type of wurk will be complied with whether specified herein or not. The granting of a pertnit does not presume <br /> lo give authoriry to violate or cancel the provision of any other state or local law regulating construction or the peAormance of <br /> construclion. That I am authorized by the owner of this propeAy fo perform the work for which application is made and I comply with ihe <br /> Slate Coqtrac(ors Law 18 7 RGW and 29�20Q WAC. <br /> .� <br /> '�� -' -�Y.--� y 7- �o <br /> Signature o - wnedContractor/Authorized Agenl Date <br /> - -1 <br />