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F`x:RMIT APPLICATI�.V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8657—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 4 �� ��� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 3S I-l��v� �D, p i n��-r- - c�� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER � ADDRESS CITYIZIP PHONE <br /> �v/ I�itr�� ��C�`11 ,y� ���t.�T—S , ` �� <br /> TENANT?lAME -- CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> C NT AC—�TOR--�^�i ��,�,'\� ADDRESS ,n CITYIZIP PHONE <br /> CONTR.LICENSG pI , �t ahv �o7� 5� 211�"��' ���- 206�3 0 <br /> �'G� t�L OSS�S 9�303� <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT i�'RICE OF WORK <br /> ��u��'�`���u�' Eleciric Gas Olher � �2�15�-� <br /> WORK OESCRIPTION <br /> Rt—PiPC 18 ��� �T Bu�u� t�c�— 11� C��p� i'iPir�G— W �—rt-4 <br /> SE�'ARr��1c S'!-l�nrt'��F V/��-VC—S �o2-�cPC.I-� lllVJ1'1-' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling uni�s <br /> � Bathtub _ Forced air systems <br /> /�L Lavalory(wash basin) Gas piping <br /> � Shower = Wa�er healer <br /> Kitchen sink&disposai Gas fireplace <br /> I Dishwasher Gasrange <br /> C�othes washer Clothes dryer <br /> Water healer _ Range hood <br /> � Sink(service/bar/mop/e1cJ _ Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeretion <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> �ti <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceAify that I have read and examined this application and know Ihc same to be irue and correcl. All provisions of laws and <br /> ordinances governing Ihis lype of work will be complied with whelher specified herein or nol.The granting of a permit does not presume <br /> to give authority to violale or cancel lhe provision of any other slate or Iocal law regulaling conslruction or lhe pedormance of <br /> consiruclion.That I am authorized by lhe owner of lhis property to perform the work for which application is made and I comply with lhe <br /> Slate ontreclors L �A 18.27 RCW and 296.200 WAC. <br /> / <br /> '�/- �� <br /> Sigry� re of 0� pOdCopt lor/Aulhorized Agent Da�e <br /> � <br />