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�+r <br /> P�RMIT APPL�CAT101n1 <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 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# RMIT# <br /> ( �o�-- fi�� �— oo4so6z o 300 � �-C�O/ <br /> LEGA LOTNO. BLOCK TRACT <br /> oesc. 3� A,� bl�ay �y <br /> OWNEfi ADDRESS CITY/ZIP PHONE <br /> �Cc�t^a.-�x.,�5��r�.������Nc �77'Zy 25i'' ►'�-e rJc L,-�, P -z�6•3Gi-s��y <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> 1—��/9 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUIL.DING HEAT SOURCE �N� CONTR,4CT PRICE OF WORK <br /> `47cCQEpiI� �Cf'�l'�� C—�I��I _Electric _Gas�Other � <br /> WORK DESCRIPTION <br /> C�GlI J� �c�.\�" �._.`-.1 `l-t�� <br /> PLUMBING MECHANICAL / 'n <br /> NO. TYPE OF FIXTURE OR ITEM �I� NO. TYPE OF FIXTURE OR 17EM Nd r, <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hor�d <br /> Sink(service/bar/mop/etc.) Exha�ist fan <br /> Backflow preventer Heatpump <br /> Grinal Unit heater <br /> Drinking Fountain ^ Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> � _ Other <br /> I _ _i <br /> I <br /> - CITY OF NERETT LOCAL SALES SAX CODE IS 3'OS <br /> I hereby ceritify that I have read and examined this applicalion and know the same to be true and correct. �II provisions of laws and <br /> i ordinaces governing this rype of work will be complied with whether specified herein or nof.The granting of a permit does not presume <br /> to give authonty to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.Tha[I am authorized by the owner of this property to perform the work ror which spplication is made and I comply with the <br /> Sta e ontractors Law 18.27 RCW and 296.200 WAC. <br /> i �� I-�-'� A � oz�ay <br /> nature of OwnedContracionAuthonzed Agent Da'te <br />