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f <br /> PEF2MIT APPLIC�TION <br /> CITY OF EVERETT PERMIT' SERVICES <br /> 3200 CEDAR STREET, EVERET?', WA °8201 <br /> � 425-257-8810- FAX 425-257-8857 -www.everettwa.org � <br /> APF'LICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS I PARCEL TAX I.D.# �?�RM/ I�T� <br /> ;�:�t.�� ��1� Y 11� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE t��S� <br /> F-�t�����o! ��1iuS�f� f�l iCc1N'� ,�S��U 1����;� �->= F���%E�/ L�,� �>���r ,�s�/�� <br /> TENANTNAME CO�JTACTFOR.PERMIT PHONE <br /> I/ <br /> ���:� � l -� l�f- L _ ! — <br /> CONTR TOR A�DRESS CITYfZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING I HFAT SOURCE CONTRACT PRICE OF WORK <br /> (-1� ( I"1.,�, �(_Uvl� �Eiactric �Gas_Olher _ <br /> � Y 1 "�C� J �, , <br /> woRK oescRiPrioN _ 1 i 1` 1'��� -i P�'f- � ��i�1CCu�C� C7�?':� ��Zs z��( <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ WC-airhandlingunits <br /> 6atlilub _ Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Walerhealer <br /> I<ilchen sink 8 disposal _ Gas fireplaco <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clolhes dryer <br /> V�'aler heater _ Ranc�e hood <br /> Sink(service/badmo��elc.) _ Exhaust fan <br /> Backllow preventer _ Heal pump <br /> Urinal _ Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> 01her — <br /> I �� CITY OF EVERETT LOCAL SALES TA%CODE IS 3705 <br /> I', I hereby ceritify thal I have read and examined this application and know lhe same to be true an�correcL All provisions o(laws and <br /> ordinaces governing Ihis lype of work will be complied wilh whelh�r specified herein or not.The granting o(a permil does nct presume <br /> � to givo aulhorily to violate or cancel ihe provision of any olher slate or bcal law rec�ulaling consWction or the performance o( <br /> � construction.That I am aulhorized by the ovmer of lhis property lo pertonn the work lor which application is made and I comply with the <br /> Slate Contrectors �aw'18.27 RCW and 296200 WAC. � <br /> �'. � iri�l�li�,�'�Y�,��'l ��'�!���'_' <br /> Signature of wned ontractor/Authonzed Agenl Dafe I <br /> � - - — — --- <br /> - ----- — _� <br />