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� �RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-Y,810— FAX 425-257-8857—www.evere'i.wa.org <br /> APPUCATIONS ARE ACCEPTED PROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ( l �O �-. ff� 9'q � � 0 µ 0�- <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS `�G � w�, cirvrz�a PNONE <br /> � l p 7� �1-0 ,N•/��r � �'��� �/��/�CG Q'�_'.��q°g <br /> L u � ,-a v .� . �. o� `. <br /> TENANT NAME/ C TACT FOR PERMIT/ � PHONE <br /> I �(voV; �,(!.v-C��W`�,S �53e�ai �� - l�/�'D <br /> ��� R ADDRES �� <br /> CONTR.UCENSE# <br /> USE OFBUILDING }iEAT SOURCE � CONTRACT PRICE OF YvORK <br /> ��o OY��1� S�l� (� _Electric �as_Other �- <br /> WOf t DESCRI ION <br /> � ��-J O <br /> , <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A!C—s�r handling unils <br /> Balhtub __ Forcedairsystems <br /> Lavatory(wash basin) __ Gas piping <br /> Shower __ Walerhealer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher ___ Gas range <br /> Clothes wa:' _ Clothes dryer <br /> Water heaf � _ Range hood <br /> Sink(servic. ' �ioplelc.) Exhaust fan <br /> Backflow preventcr _ Heat pump <br /> Urinal _ Unit heater <br /> _ Dri:�king Founlain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify lhat I have read and examined this application and know the same te be lrue and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whe!her specified herein or not.The granting oi a permit does not presume <br /> to give authority to violate ur cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.That I an: authurized by the owner of this propeRy to perform the work for which application is made and I comply with the <br /> State Contr ctors Law 16.27 RCW an 796.200 WAC. <br /> u �� � 3 - a7 <br /> Signa re of wner Conlracto lhorized Agent Date � <br /> � <br /> Z <br />