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ERMIT APPLICAT N � <br /> CITY OF EVERETf PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.evwettwa.ary <br /> APPLICATIONE ARE ACCEPTEO FROM d AM TO 1�M /f �-/Z ^'a� <br /> 8fTE ADDRESS� PARCEI TAX I.D.A p��•�p p� <br /> ov-�'d� / <br /> LE LOT N0. BLOCK TRACT OR SUSDNISIOM� <br /> DESC. <br /> NE • <br /> �e ' <br /> TENANT NAME I FOR R MIONE��(p —�L� <br /> �� e EdAAIL — <br /> CONi}t.LICENEE N � )��� <br /> 1�... <br /> USE OFBUIL ING HEAT 80URCE CONTRACT PRICE OF WORK <br /> s� _Elechic �Gas_Other � 1� ,(�.Crj <br /> WORK DE RIPTION �\ _ , ���e� <br /> �v�w <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM �• �E����� <br /> Toilet _ A/C—alr handlkp units <br /> 8athtub _ Forced ek eyslems <br /> _ Lavatory(wash basin) _ �s P�W�W <br /> Stwwer _ Wa�heater <br /> _ Kitchen sink 8 disposal _ �s�� <br /> Dishwasher — �� <br /> Clolhes washer -- ��� <br /> Water heater — ��8� <br /> Sink(servicelbadmopletc.) — E��� <br /> Backflow preventer — ��� i <br /> Udnal _ Unk hsaler I <br /> _ Drinking Fountain �� <br /> Floor drain — R��� ; <br /> = Grease trap — ��� i <br /> Roof drains — <br /> Other — , <br /> CITY OF EVERETT LOCAL lALES TAX COOE N]106 <br /> I hereby ceritlfy that I have read and exemined Ihis applkadon and know the eame lo be trus a�d canct• AN ProNtiom a laws and <br /> ordinaces goveming this type of work will be complled with whelher specifled herein w rat The pronfNq ot a pem�lt doss not p►ssums <br /> to give authority lo violas cancel the provisbn of any other state or bcal law repulatlnp canetructlon or the perbmiencs of <br /> conswctlon.That ISm nzed by the owner of lhis properly lo perform 1he work for whid�eppl{catlon is mede and�oomp�Y wNh Ihe <br /> Slate Contrxlors 182 and 29,8�0 WAC. <br /> , � .�=- , „ /�-�- 9 � � 1 <br /> Signature of OwnerlConlractor Aut onzed Agent e `I L <br /> l <br />