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PcRMIIT APPLICA <br />EVERETT PERMIT SERVICES <br />3200 CEDF�R STREET, EVERETT, WA 982�1 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />CEL TAX I.D. i{ <br />-00%G�d-(5nD <br />cii'F:�Er-/i�,vs-i.�G 3ic�,' lo«Y .9r/� �r��ii9�1n/ S�1,T3�.3.//Z / <br />A��T/'/o.�iT;i <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />s,�%/f"� .�cii/ �'��FF f1.�.��Gs 9d <br />cor�rancTOR <br />F'UF,E'F7lf%-/l�iVG ,Q�7Ho�'iTy <br />CONTR. LICENSE ft <br />������/�f' ����f `� <br />Toilel <br />Bathlub <br />Lav2lory (wash basin) <br />Shower <br />Kilchen sink & dispasal <br />Dishwasher <br />Clolhes washcr <br />bVatcr healer <br />Sink (servicelbar/mop/e�c.) <br />Backflow prevenler <br />Urinal <br />Drinking �ounlain <br />Floor drain <br />Greasc trap <br />Root drains <br />Olher <br />HEAT SOURCE CONTRACT FRICE OF WORK <br />ric V Gas _ Other ���1� � <br />�.�/STi•✓v .�E"s/GF'�C� <br />A/G — air hantlling units <br />Forced air systzms <br />Gas pipinc� <br />Waler healer <br />Gas (ireplace <br />Gas range <br />Clathes dryer <br />Range hood <br />Fxhaustfan <br />Heal pump <br />Unil healer <br />Boiler <br />Refric�eration <br />Woodslove <br />Other_ _ <br />I hcreby ceriti(y that I have read and examined this application and know the same to be true and correcL All provisions of laws and <br />ordinaces goveming this lype of work will be complied with whelher speci(ied herein or nol The granting o( a permil does not presume <br />to give authority to violate or cancel the provision of any olher state or local law regulating constr�ction or the per(urmance of <br />conslruclion. That I am authorized by �he owner o( lhis property lo perform the work for which applicalion is made and I comply with the <br />Slale Cry�efors Law 18.27 RCW and 29G200 WAC. _ <br />