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I�iRMIT APPLICATI�rN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610— FAX 425-257-8857—www,everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� ��/ <br /> v <br /> SITE ADDRESS PARCEL TAX I.D.� RMIT N <br /> % - /oc D / oo �G io �• �3 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �UE�PETI� �u5�,,�� i¢��tl. ���L 3/a7�16.� av � 9��/ Ya•s-.��l�zi <br /> TENANT NAME —� ONTACT FOR PERMIT PHONE <br /> S�� t_ S�' v� Ke�� Y�5= 5'oR' 6 s�? <br /> CQNT$�C����'�l ��0�`1 qDORESS CITY2IP PHONE <br /> �V�R��� y. +'� 3l07 t�o/��. �u.c qyatol <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> _Electric l�Gas_Other 9 <br /> WORKDESCRIPTION C V 6r51���nt GO � � Q�n.It'�qyc — V a,LK .r0 Sa-mt, <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO, TYpE OF FU(TURE OR ITEM <br /> _ Toilel AIC–airhandlingunils <br /> _ Bathtub Forced a(r systems <br /> _ Lavatory(wash basin) Gas � in <br /> Shewer — P P 9 <br /> — Water heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gasrange <br /> _ Cbthes washer Cblhes dryer <br /> _ Water healer Ranga hood <br /> _ Sink(service/badmop/etc.) Exhaust fan <br /> _ Backfiow preventer Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trep Woodstove <br /> _ Roo(drains Olher <br /> Other — <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y thal I have read and examined lhis applicalion and know the same lo be true and correct All provlslons of laws and <br /> ordinaces governing tliis type of work will be compliod wilh whelher specified herein or not.The granting o(a permit does not presume <br /> to give aulhority lo violale or cancel the provision of any other slale or local law regulating construction ar lhe perfortnance ot <br /> conslruction.That I am authorized by tho owner of this property to perform the work for whfch applicaUon is made and I comply with the <br /> Stale ontraclors Law 18.27 RCW and 29G.200 WAC. <br /> � r���-� lL�/�.� <br /> Signature wnedConlrac orlAu nzed Agent ate �/ <br /> 2 <br />