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F�. .RMIT APPLICATI� ,� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8840—FAX 425-257-8857—www.everettwa org <br /> APPi.ICATIONS ARE ACCEPTEU FROM 8 AM TO 4 PM /�,., S•�/� <br /> SITE ADDRESS PARCEL TAX I.D.il PERMIT# <br /> :;do � � � � - c�r�e <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> D[SC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �-;�-�a�-e_�� ��u �.n C� �`�,� <br /> TENANT NAME CONTACT FOR PERMIT PHONE /� p <br /> � T Y 1 l- ( 1 . l�N —1� � � � ti 5'{- . 1�6�A(L� (�..Q�.�3' �1J1 T-�'CJ�U� <br /> ON R R ADD $ I?Yl�Z�— � <br /> � 7 �;33S - <br /> CONTR.LICENSE p �—`� " (/" � � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other I <br /> WORK DESCRIPTION <br /> ��,�� r� s�.s,�-�. �/-e���� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. � TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling unils <br /> Bathlub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> � Backflow prevenler _ Heat pump <br /> Urinal Unit fieater <br /> Drinking Fountain Boiier <br /> Ploor drain R�frigeration <br /> Grease trap Y!oodstove <br /> Roof drains Other <br /> Other _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby certify that I have read and examined this application and know the same lo be true and correct. All provisions of laws and <br /> ordinances governing this type of work•vill be complied with whether sperfed herein or nol The granting of a pertnit dces not presume <br /> lo give authorily to violate or cancel Ihe provision of any other state or!o:ai law regulating construction or Ihe performance of <br /> r,onslruclion. That I am authorized by Ihe owner of this proparty to perform the work for which application is made and I comply with lhe <br /> Sla(e Contractors Law 18.27 RCW nd 296.20 AC. , <br /> �/� _ � '��C' <br /> ignature ot�OwnedCo actodAutho � ed t - Date <br /> �__r <br />