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i- cRMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERI/ICES <br /> 3200 CcDAR STREET, EVERE i T, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM f D -� L(-� <br /> SIl'E ADDRESS PARCEL TAX I.D.# P-RMIT# <br /> �� �JLYC�1"Fy�il ��� ���`-;� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISIOtJ# <br /> DESC. <br /> OWNF�R ADDRESS rCITYIZIP f PHONE � <br /> �"� �=PL-S -�-VIC� �CJ�i S-�'a�eS Q-`,'�i' -1�/C�muU�blU.wl/(� ���d2- <br /> TENANT NAME CO/NTACT FOR 1FERMIi PHONE 3�(} ��-I-S L �TS � <br /> �.�-�q�s �b J�'kt�d�?ri+aH' -YV�C� E-MAILd�.2�dS�i11W��M��e <br /> � <br /> CONTRACTOR � ADDRESS 1 CITYIZIP PHONE <br /> , /�. �� <br /> CONTR.LICENSE# � <br /> .�l�' r�GL (�f`�-'�Gt c � <br /> US�OF BUII_DING HEAT S�RCE CONTRACT PRICE OF WORK <br /> �.{-:_�l ( Co„���_�cic�l � �,.J eoC7 <br /> Eleclric � Gas Other <br /> WORKDESCRIPTION�¢K4�n.} i.��'���¢W�ex��- '" f�nS'�"� V`a`.,.� S'�'O�IefTon an ��'t�-Y� � <br /> r^ n O�zL(Q"f� � o`�ta i 1'\ G„h C1vh <br /> ,'�tlW f ta7,-s a_wZ1 ?,..;slbS �..$�,..5-�., v�,c...� c � a � P; <br /> _,�,�_rcfl:�I-aP--Q,=--av�s��- <br /> PLUMBING , MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM \ NO. j'�' TYPE OF FIXTIIRE OR ITEM <br /> Toilet X� �A/C—air handling units <br /> 6alhtub � Forced air systems <br /> Lavalory(wash basin) `_ Gas pipinc� <br /> Shower aler healer <br /> Kitchen sink 8 disposal _ s fireplace <br /> Dishwasher �' _ Ges�range <br /> Clolhes washer � Clotlies dq�er <br /> Waler healer � Ranye hood <br /> Sink(service/bar/mop/elr,.) _ Exhaust fan <br /> 8ack0ow preventer ' _ Heal pump <br /> Urinal Unit lieater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> i Grease Irap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> I hereby ceriti(y that I have read and examined this applicalion and know lhe same to be true and correcl. ^II provisions of laws and <br /> ordinaces goveminc�lhis lype of work will be complied with whether specified herein or nol.The granting of a permil does nol presume <br /> io give authority to violale or cancel the provision o(any olher state or local law rec�ulalinc� construction or ihe performance of <br /> conslruclion.Thal I am aulhorized by Ihe owner of lhis property to perform the work for which application is made and I compty v+iUi the <br /> Stale� ntraclors Law 18.27 RCW and 296.200 WAC. <br /> _ � <br /> ���1 t � ,�-�� ��-�2 N W �'��W.'�- �MC O X�� ��o � <br /> Signalure of OwnedConlraclor/Aulhorized Agent D te i/ <br /> !L <br />