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��RMI'' APPLICATIVN <br /> CITY AF EVEhETT PERMIT SERVICES <br /> 3200 CEDAR STRFET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.o�g <br /> IAPPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> %c�2zy �i'd„ h,; �Iv� oo- ` I -ocx�- Uiy-ao '� gjb - aiC� <br /> LEGHL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. 1�' OG �ct�rmo��n� �s��e5 17iv �10. <br /> OWNER ADDRESS CITYIZIP PHONE y2-� <br /> lJc.r�� r ,,e� ' r.+n�j��ler� lo'LZ�{ ���.�`u f�C EVr .c� IOaG�I J�{ )—�l �r �+ <br /> I <br /> TENANT NAME CONTACT FOR PERMIT PHONE Y 2S 34 7 ��1�+�� <br /> �.�y� �-�^'�Pine.� E-MAIL S ��e.^�e^•s�VG� z.;n, t� <br /> CONTRACTOR ADDRE55 qTY/ZIP PHONE <br /> CONTR.LICENSE# � � <br /> %�,L('.�(._.� <br /> USE OF BUILDING I�IEAT SOURCE CONTRACT PRICE OF WORK <br /> �—�p�, �;,��, _Electric _Gas_Olher <br /> WORK DESCRIPTION I � , F j ,[- <br /> �l, ��OQY"1 0.0C..�ion to ?�(I��T.�� �'lou•S 'L � �� / <br /> PLUMBING MECHANICAL <br /> NO. TYpE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � � � Toi��t AIC-air handling unils <br /> BaGilub _ Forced air systems <br /> �� Lava(ory(wash basin) __ Gas pipinc� <br /> �x_ Shower _ Water healer� "�/� � <br /> _ {Ci;chen sinh& disposal _ Gas tireplace �07� / �}�� <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> _ Waler healer Ranc�e hood <br /> Sink(service/barhnoplelc.) � Exhausl lan <br /> DackOow preventer Fleat pump <br /> Urinal Unil healer <br /> Drinking Founlain . Boiler <br /> Floor drain Refriyeration <br /> Grease trap Woodslove <br /> Rool drains Olher <br /> Olher <br /> I — — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I here6y ceriti(y Ihal I have read and examined this�pplir,alion and hnow the sama to be Pue and correcL All provisions of laws and <br /> ordinaces goveminc� lhis lype o(work will be complied;�ith whelher specified herein or nul The yranling of a permi�does nol pr�sume <br /> to give aulhonty to violate or cancel the provision of any other slale or local law regulali�g construction or the performance o( <br /> I conslr�clion. Thal I am aulhorized by the owner of lhis property to perform lhe work tor which applicalion is made and I comply wilh Ihe <br /> Slale CoNractors Law 1827 RCW and 296.200 WAC. <br /> ,� <br /> I t'L" /o�1o�a9 <br /> � <br /> Signalure of Owner/ConlraclodAulhorized Agenl Date �/z <br /> ` _. _ .---- --- --- � -- - --. ..- .. -- -- -- ---- � <br />