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' ,. <br /> PtRMIT APPLICATIUN <br /> CITY OF EVERETT PERMlT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810– FAX 425-257-8857–www.everettwa.org �_ a 3– 0 6 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �,ITE ADDRESS PARCEL TAX I.D.# RMIT# <br /> ,����z ywyg� # � �l r�� ����- o0 <br /> L-GAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITV2IP PHONE <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �� <br /> K�/�'G/ �6-�= Y-d�z� <br /> �$//�i!/f/ �/s"��'� e.r,�a� <br /> CONTRACTOR ���/�� Gp�� ADDRESS � P <br /> �� 5 G,q�'✓o� s-> � �ia�l�e- , r.�/� f'�i3� <br /> CONTR.LICENSE# ���a-�SC `7�,���/ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PniCE OF WORK <br /> /C���/�7il�C/��-�� _Electric x Gas_Olher �Ud Q � �D <br /> WORK DFSCRIPTION <br /> z;vs�,�� rv � ti�oa <br /> �—f�N�fS�� �fly , ��L?l�E U/� A/r ,LEG/a>Z�� /��/C� G�o�/C <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Snower Waler healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water healer _� Range hood <br /> Sink(service(badmop/elc.) � Exhaust fan <br /> Backflow preventer _ Neat pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiier <br /> Floor drain Refrigeretion <br /> Grease trap Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined lhis application and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governing this lype of work will be complied wilh whether speci(ied herein or not.The granting of a permit does not presume <br /> to give authoriry to vlolale or cancel the provision o(any other state or Iocal law regulating construction or the performance of <br /> construclion.That I am aulhorized by the ok�ner o(lhis property to perform the work for which applicalion is made and I comply with the <br /> Slafe Conlractors Law 18.27 RCVJ—and 296.200 WAC. <br /> /�y_�,%' —.� i/ /OS/G'�/ <br /> Signaturey Owne oniraclodAuthorized Agent Date <br /> ��Z <br />